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diff --git a/75284-0.txt b/75284-0.txt new file mode 100644 index 0000000..cfa72ed --- /dev/null +++ b/75284-0.txt @@ -0,0 +1,6339 @@ + +*** START OF THE PROJECT GUTENBERG EBOOK 75284 *** + + + + + + AN INQUIRY + INTO THE + PROPAGATION + OF + CONTAGIOUS POISONS, + BY THE ATMOSPHERE; + AS ALSO +INTO THE NATURE AND EFFECTS OF VITIATED AIR, ITS FORMS AND SOURCES, AND + OTHER CAUSES OF PESTILENCE; + WITH + DIRECTIONS FOR AVOIDING THE ACTION OF CONTAGION, + AND + OBSERVATIONS ON SOME MEANS FOR PROMOTING PUBLIC HEALTH + + + BY + + S. SCOTT ALISON, M. D. + + TRANENT. + + “I have long thought that there is no subject on which a Physician could + employ his time and ability more advantageously for the benefit of his + fellow-creatures, than in the investigation of febrile Contagion, in + order to ascertain the laws by which it is communicated, and by what + means it may be prevented.” HAYGARTH + + EDINBURGH: + MACLACHLAN, STEWART & CO.; + LONDON, WHITTAKER & CO. + 1839. + + + + + PRINTED BY NEILL AND CO., OLD FISHMARKET, EDINBURGH. + + + + + PREFACE. + + +The Author trusts that the importance and the accuracy of the facts +which have been detailed in the following Work may, in some measure, +counterbalance the many defects which will doubtless present themselves +to the reader. + +The progress of the Work has been interrupted, on innumerable occasions, +by the unceasing labours incident to the life of a country medical +practitioner; and though many of the facts and arguments which have been +used, have long obtained the author’s attentive consideration, their +reduction to the present form has only now been accomplished during the +short intervals which he has seized, after the fatigues of the day had +been concluded. + +The author relies with some confidence on that indulgence which he hopes +will be extended to the work of one who contributes, for useful +purposes, the results of his experience, derived from an intimate +knowledge of the condition, habits, health and diseases of the various +classes of the population of a considerable extent of country, of which +his situation has put him in possession. + + S. S. A. + + + TRANENT, _March 1839_. + + + + + CONTENTS. + + + PART I. + + INTRODUCTION Page 1 + CHAP. I. Prevalence of Doctrine of Atmospheric Contagion, Injury + to Patient, Attendants, and Visitors 7 + CHAP. II. Medicine retarded—Forms of Contagion 18 + CHAP. III. Historical Sketch 25 + CHAP. IV. The Absence of Sufficient Evidence of the Existence of + Atmospheric Contagion 36 + CHAP. V. Contagious Poisons—Non-Solution in the Air—Results of + Experiments 40 + CHAP. VI. Contagious Poisons, compared with Yeast—Does that + agent assume the Aeriform State? 50 + + + PART II. + + CHAP. I. The Negation of Atmospheric Contagion from the History + and Actual Observation of Disease 56 + CHAP. II. The Evidence drawn from Disease attacking the + Relatives, Attendants, and Visitors of the Sick, in favour of + Atmospheric Contagion, considered—Facts explained 67 + CHAP. III. The argument drawn in favour of the Propagation of + Disease by Atmospheric Contagion, from Disease appearing in + previously Healthy Houses and Localities to which Persons + sick, or lately so, have been removed 86 + CHAP. IV. There is no evidence that Atmospheric Contagion + travels, or is communicated from one place to another 89 + + + PART III. + + CHAP. V. On Vitiated Air 96 + CHAP. VI. Air Vitiated by Admixture with Effluvia arising from + the Decomposition of Vegetable Matter on the Surface of the + Earth 112 + CHAP. VII. Malignant Fever 126 + CHAP. VIII. General Diseased Condition of the Body, the Product + of Malaria 132 + CHAP. IX. Other causes of Pestilence—Famine—Unwholesome Food and + Drink 140 + CHAP. X. Causes of Pestilence continued—Cold, Want of Clothing, + and Shelter—Depression of Mind—Influence of Weather, Climate, + Habits, &c. 152 + CHAP. XI. The Avoidance of Diseases marked with Palpable + Contagious Poisons—The Limited Range of Action of Contagion 165 + CHAP. XII. The Prevention and Correction of Vitiated Air 172 + CHAP. XIII. The Prevention of Vitiated Air in connection with + the Disposal of the Dead—Offals—Construction of Towns, Houses, + Sewers, &c. 190 + CHAP. XIV. Prevention of Disease by an Active and Cheerful State + of Mind, Sufficient Clothing, and Wholesome Diet 206 + + + + + AN INQUIRY, &c. + + + + + PART I. + + + + + INTRODUCTION. + + + “Les hommes sont bien malheureux! ils flottent sans cesse entre de + fausses esperances et des craintes ridicules; et, au lieu de s’appuyer + sur la raison, ils se font des monstres qui les intimident, ou des + fantomes qui les seduisent.” + + MONTESQUIEU. + + +The author of the following pages has been induced to lay before the +public the details of an investigation into Atmospheric Contagion, from +the following considerations. + +_1st_, That there prevails among the public, and especially among the +relatives of the sick, much unnecessary alarm on that subject. + +_2d_, That much injury is inflicted upon the poor patient, who is often +made to suffer great and cruel privations, from the neglect and +desertion of friends in a state of panic. + +_3d_, That a great obstacle to the progress of Medical Science, is +raised up by the belief in the existence of Atmospheric Contagion. + +_4th_, That there exists relative to that subject, much confusion, from +the misapplication of terms. + +He has thought that these are important grievances, and that a little +labour would go far to remove them. He is satisfied, from the +investigation that is shortly to be detailed, that Atmospheric Contagion +has no existence; that consequently all the apprehension felt upon the +subject is groundless, and that the many painful measures which the +public adopt, for their security, are totally unnecessary. + +On a subject, too, touching such important considerations as the +dreadful panic often experienced when pestilence is ravaging; the safety +and ease of mind of the public; the discharge of the most sacred offices +of kindness and consolation to their sick and dying fellow-men; and the +progress of medical science, he has felt that the public must take a +deep interest, and that he is warranted in treating it in a style fitted +for popular perusal. + +It must be granted that the British nation, whose sympathy is not +confined among themselves, but exists for the various tribes of the +human race, civilized and savage, must willingly lend an ear to an +argument, whose object is, to shew that their own safety from +pestilence, does not require them to be placed in the painful and cruel +position, of withholding their aid from a suffering and helpless +fellow-creature; of disregarding the cries and the imploring and +eloquent looks of the dying; of forsaking the sick-bed of a father or a +brother, denying the tender and unpurchaseable offices of friendship, +and of ruthlessly breaking asunder the sacred bonds with which God has +wisely and indulgently joined us. + +They, whose hearts are open to the appeal of the forlorn slave, must be +gratified to hear that they may perform the offices of humanity to their +sick relatives and friends, without, as has hitherto been thought, +subjecting themselves to the almost certain invasion of disease; that +they may watch the last moments of an expiring friend, minister to his +latest wants, and have the melancholy gratification of standing by him, +when about to make the last and most awful change that can overtake him. + +It is expected that it will be shewn, that the sick-room is at all times +free of the poison with which it has been believed to be contaminated, +and that the atmosphere there, if attention is paid to ventilation, &c. +is almost as wholesome as that out of doors. + +The air which the sick respire does become impure, but not on ordinary +occasions in a manner different, or with a greater virulence, than is +observed in the case of air in a small and close apartment, respired by +many persons closely huddled together. + +The history of sick chambers presents no instance more dreadful than +that of the Black Hole of Calcutta, where so many perished of corrupted +or vitiated air. + +The subject of infectious air touches directly upon the most important +interests of mankind, concerns intimately their safety, the duties of +man to man, and even the very affections of the heart. + +As the subject at present stands, the public is awkwardly situated; +believing that they must either endanger their health, even their lives, +or allow their friends and relatives to perish unassisted. + +The author thinks he is under no obligation to apologize for attempting +to shew, that the public may at once perform all the charities of life +to the sick, and avoid the action of a virulent poison. There can be +none necessary, and he even hopes that his inquiry may tend to obtain +for many, who are yet to be the victims of pestilence, that succour from +hands they love, which, alas! has been withheld from thousands. + +It has not been usual to write speculative medical opinions in a popular +style, but the author is of opinion that an inquiry bearing on matters +so important, should be made known to those whom it most concerns, +certainly, the people; and he is convinced, that in a simple case of +evidence such as this, that they are qualified to decide, provided there +is a full and impartial leading of facts on both sides, and there be +absence of all technical terms and purely professional phrases. The +discussion will be conducted on plain and obvious principles, so that +the merits of the question may be appreciated, at once, by them and the +profession. + +The public is already informed of much that relates to the animal +economy in health, through the assistance of many admirable works which +have been published within the last few years, and it is not unfair to +suppose that they may be interested in hearing, and likewise capable of +understanding, a case relative to disease. + +The community is aware that Medicine is not now the subtle, hidden, +affectedly mysterious art, it was at no very remote date; and that its +present enlightened professors now seek not the assistance of darkness, +of silence, to disguise their ignorance and questionable views, or to +heighten the impression of the skill and cunning of their order. + +Its study is now conducted openly, and its foundation, happily, is laid +upon principles established in nature that are as well known to the +unprofessional as to the professional man. + +There is no wish to disguise matters from the public, and, were it +attempted, it could not possibly succeed. + +The utmost care will be observed to lay the evidence impartially down, +plainly, and divested of technical phraseology; and, satisfied of the +general ability of the public to judge, the author will await their +decision with as much anxiety as that of the medical world. + +It will afford the writer the return he most values, if, by his means, +less anxiety and apprehension are felt in future among the public on +occasions of disease; if those acting under a sense of duty are enabled +to discharge their humane offices with less feeling of danger; if the +patient remain unoppressed with alarm for the dear ministering friends +around him; if even one sufferer be spared the anguish of bearing wants +unanswered, and if in his last hours he is spared the bitterness of soul +he must experience, when deserted by those to whom, through life, he +looked for comfort and support. + +The author has also been induced to publish his views upon vitiated air, +its nature, sources and effects, with directions for its prevention, +avoidance, and correction. Vitiated air has been confounded with +atmospheric contagion, has performed the greater part of the work of +death attributed to that agency, or supposed agency, and it has been it +that has been affected and controlled, when both non-professional people +and the medical world thought systems of quarantine, isolation, gens des +cordons, (contagion police,) and fumigations, were effecting the objects +for which they were established. + +The immediate objects of these counteracting agents, the destruction of +contagion and contagious atmosphere, &c., could not be effected, since, +at least, the latter does not exist: but fortunately, though they could +not effect the objects immediately proposed, the ultimate ends have been +served, by their acting on many occasions upon the efficient causes of +disease, viz. vitiated air. + +They were useful after the fashion of the medicine and charms in olden +times, used for the expulsion of evil spirits, devils, and the like, +which, by their natural action upon the functions of the body, corrected +derangements which were mistaken for the operations of these imaginary +beings. The Author has pointed out other causes of pestilence, and has +given some directions for their prevention, and for the preservation of +health. + + + + + CHAPTER I. + PREVALENCE OF DOCTRINE OF ATMOSPHERIC CONTAGION, INJURY TO PATIENT, + ATTENDANTS AND VISITORS. + + +Atmospheric contagion, to which public attention is directed, has been +regarded for many ages as the cause of a great proportion of the +pestilence incident to the human race; and, at the present day, most of +the diseases which are wont to be widely spread, and to be very mortal, +are usually considered as depending on that agent, both by the +unprofessional and the medical world: indeed, so extended has been +thought its sphere of action, that it is suspected to be operating in +almost every case that occurs, of those diseases which usually attack +many at the same time; and, in nearly every instance, its existence is +positively inferred, where previous cases can be shewn to have been +prevailing, though at the distance of several miles. + +It is a fact familiar to many, that, on the occasion of the late +prevalence of Cholera Morbus in the years 1831 and 1832, that infection, +through the medium of the air, was considered the most common cause of +the propagation of that scourge; and every mother is taught to regard +every case of scarlet fever, common fever, hooping-cough, and many such +disorders, as a very centre of infectious air that possesses qualities +subversive of the health of her children. + +Ordinary conversation, too, marks well the common belief in the positive +injury that agent inflicts. In general, it seems a matter quite out of +the question to suppose, that the patient may have got his sickness from +the operation of other and distinct causes, as is sufficiently evident +from such common questions as these, “Had he visited any person ill of +the same complaint?”—“Where, and from whom, did he get the infection?” +and likewise from the ordinary replies, “He got it from a friend, at +whose house he called to inquire after his health,”—“He caught it when +passing through a street in which a person lay ill of the same +distemper.” Such inquiries and replies are made not only by the public, +but by the medical profession also, who are, in general, sufficiently +satisfied if such answers and solutions as those above be given. Were it +necessary to say more to prove the important position infection holds as +a cause of disease, and as the chief instrument of its propagation, +references might be made to thousands of instances, narrated, too, on +medical authority, where whole visitations of pestilence have been +attributed to its operation, and volumes might be filled with the most +skilful artifices, devised, and actually carried into execution, to +deprive the air of its invisible poison; but these steps are deemed +unnecessary here. + +The belief in the doctrine of atmospheric contagion is hurtful to the +patient by its direct influence on his mind, and the gratification of +his wishes. + +The patient laid on the bed of sickness, having many wants and occasions +for a thousand little offices, but being unable to assist himself, +generally desires, and, where apprehension does not cause desertion, +obtains the aid of good and gentle friends, whose very presence affords +a gratification to the sufferer which none can sufficiently value, who +have not, like him, felt its blessings. Their assistance and constant +presence is absolutely necessary to supply his several wants, and to +render a situation, often painful, and ever irksome, less acutely so. + +But not more necessary is such assistance to the mitigation of the +sufferings of the body, and the soothing, the calming of a fevered mind, +than is it urgently wished for, and longed for by the patient, to whom +even the momentary absence of the ministering being from his bedside is +frequently the cause of much mental agitation and of pain. + +But where, as we have often seen, the patient has still his senses left, +and dearly loves the objects around him, what must be the amount of that +bitterness of mental struggle going on in his breast, alternately +heaving with desire for their presence as his greatest comfort, and with +the alarm every amiable being must feel, lest those most dear to him +should fall the victims of their tenderness, and be cut down themselves, +in their holy endeavours to relieve his sufferings? + +The apprehensions of the patient lest those kind and beloved friends +ministering to his wants, and nobly incurring on his account all the +risk of a dangerous situation, should unhappily derive from him, through +the medium of Atmospheric Contagion, the same disease,—are calculated to +produce a state of excitement highly injurious and directly opposed to +that calm and cheerful state of mind so favourable to his recovery. But +these apprehensions are often changed for the dreadful reality, and no +little mental suffering has been produced, and no trifling obstacle to +the convalescence of a patient has been raised up, by the intimation +that a dear friend has caught the pestilence from him, and has in +consequence been deprived of life. + +The belief in the doctrine of Atmospheric Contagion is hurtful also to +the friends and attendants of the patient—by its naturally conveying the +impression that he is a centre of a poisonous agent, whose immediate +tendency is to propagate the distemper and diffuse itself through the +atmosphere, extending to it, its deleterious attributes, to be felt by +all who respire it. + +The poison is said to diffuse itself in the air of the apartment; hence +it is believed, that entering into the apartment is tantamount to +destruction, or at least, is nothing less than exposure to an influence +of the most virulent and deadly quality. + +It does not at the time signify to the attendants, the evidence on which +the doctrine rests. It is believed, and that is enough to cause the most +baneful effects upon the spirits, to inspire the worst apprehensions, +and has also, as is well known, produced those very effects they had +feared from its operation, has caused the increase of disease, nay, +death itself, and that not on one occasion only, but on many. + +The most common causes of Pestilence, Plague, Putrid and low Fevers, and +Cholera, are mostly of a depressing nature, and, usually, the more they +partake of that character, they are the more effectual in their +operation. Famine is chiefly favourable to the sickness which is usually +coincident with it, from the depressed and feeble state of body it +produces; and an impure atmosphere is deleterious, chiefly from its +allowing the body to become less energetic, by withholding that vigour +and elasticity which the respiration of pure air imparts to the system +at large, and thence to the mind. + +These are powerful depressing causes, but not more so than fear, +especially that kind that is deep and lasts long. Moral philosophers +rank Fear as one of the most depressing passions, and its +characteristics with the artist are paleness, contraction of the +features, the best and surest indication of a weakened circulation (of +blood) and diminution of vital power. The first are well aware of the +hurtful influence it imparts to the whole body, and narrate instances, +on excellent authority, where death, even immediate death, has been the +consequence, where the brain has had its functions impaired, and thus +imbecility induced; so that in short, they are accustomed to regard it +as one of the most powerful agents, applied both to the mind and body. + +The Medical Philosopher, too, has frequent occasion to mark the great +depression of the powers of the body, the imperfect discharge of its +functions, and the general exhaustion consequent upon the long continued +operation of apprehension. + +Be the apprehension of whatever nature, it is always detrimental—in a +ratio too, proportionate to its intensity, and its other contingent +circumstances. In the lesser degrees, it causes indigestion, flatus, +loss of appetite, headach, and often general restlessness, with feelings +of great discomfort. + +It is found operating with great force, whether it arise from +apprehension of damnation in respect to a future state, of ruin in a +pecuniary point of view, or perhaps from what is most immediate and +striking in its effects, of catching the infection of pestilential +disease, which is the point with which we have most to do. + +We have known many persons much affected with the fear of taking +infection, and allowing this to prey upon their spirits, who were among +the first attacked with pestilence; and if any weight is to be given to +our knowledge of the probable causes of disease, there is great reason +for concluding that those persons were the victims of their very fears, +more than of any other causes of a prejudicial character. It is often +impossible, with complete justice, to say decidedly that any one +influence has been the exclusive cause of disease, when there is room to +think there are, or may be many ready to operate; but, in many +instances, the relation has been so immediate, and so striking between +the known presence of depressing apprehension, and the supervention of +sickness, that there is no room left to doubt the propriety of placing +them in the relation of cause and effect. It must be familiar to many, +quite a common occurrence, and one of which we heard constantly during +the ravages of Cholera a few years ago, that persons took that disease +from mere fright, and of the attack having been very much encouraged by +its operation among the attendants, and more especially of those +believing in the existence of the infectious nature of the disease. + +These facts, it is thought, will prove that the doctrine of Atmospheric +Contagion is calculated to excite much apprehension among the attendants +and visitors of one sick of pestilence, and to shew in what manner that +very apprehension is disposed to produce disease. + +The attendant or visitor persuaded of the atmospherically contagious +character of the disease, must possess considerable fortitude to venture +at all into the presence of the patient, and even when once there, he +must possess more than common hardihood, who does not feel more or less +depressed with apprehension for that potent, and not the less imposing +agent, because invisible, which, like a drawn sword, hangs over him, and +threatens his existence. + +By the belief in the doctrine of Atmospheric Contagion, the attendant +not only becomes, in general, exposed to one of the most common and +efficient causes of disease, viz. fear, but his offices are performed +more as a duty than as a gratification, which it is to a well disposed +mind, where no extraordinary danger is encountered, and he is thus +forced to make a sacrifice of his feelings, and the valued assurance of +security to a rigid sense of duty; but however much such conduct may +agree with morals, it is detrimental to health. + +It is hurtful also to the patient, from its influencing so far those, +who, by relationship, by previous terms of friendship, and by duty, are +bound, by every moral obligation, to assist him, now helpless, sick, and +perhaps expiring,—as to forget their most sacred duties as to make them +disregard his forlorn situation, and indeed to induce them to fly from +and desert him; thus sacrificing every good principle and wholesome +consideration, (as they erroneously think) to make their own lives the +more secure. + +Such contingencies are of frequent occurrence; and the result is, that +many unhappy persons are left to perish, their thirst unslaked, their +latest requests unheard, and their last moments unwitnessed. Parents +have been known to forsake their children, and the offspring their +parents, whom, at all hazards, they were bound to serve,—by every holy +affection, to assist the more diligently, the more they were pressed +with adversity. + +But alas! the affections, the instincts of Nature, the dictates of +gratitude, have been thrown aside, and every thing fair and holy in the +human soul has been foully stained, in the almost universal wreck, +attendant on the course of pestilence. + +The history of the cholera visitation affords many examples of perishing +persons deserted and left to the mercy of a cruel scourge; and we are +familiar with many instances which have come under our own charge, where +it has been found impossible to procure the attendance of relations, or +even the mercenary aid of hirelings, although extraordinary remuneration +has been offered. + +Last winter, the father and mother of a family were seized with fever, +and their sole attendants were their infant children. There were several +relatives of the family not far off, but none, not even one, could be +persuaded to lend assistance. Their neighbours refused to hold any +communication; and, notwithstanding repeated and continued attempts by +the Author to induce those who make it their business to wait upon the +sick, the family had to struggle on, without the least attention being +paid, saving by the almost useless children, to their wants, to +cleanliness, and to the administration of the remedies. + +It was truly a deplorable scene, such as made the Author reprobate that +cowardly desertion, and regret the operation of a doctrine so baneful, +and moreover so groundless. Yet we know not whether to blame most the +people or the doctrine. Did those see the scenes, the distress and +cruelty inflicted through the operation of infectious air, who believe +in it, and preach its avoidance; surely, did they possess one spark of +humanity, it could not fail to manifest itself, by causing them to +institute, or at least to listen to, an inquiry touching its evidence. + +The medical attendants are not free from the hurtful operation of this +doctrine. If believers in infectious air, they are under a feeling of +apprehension which, perhaps with some, may not be strongly felt, on +account of the frequency of impunity from exposure; but with many it is +strongly felt, and influences their attendance on the sick, their +communication with them, and their own comfort and feeling of security. + +Many instances are known—they are of very frequent occurrence—where the +physician, from apprehension, has failed to pay so many visits as were +necessary, or to remain with his patient sufficiently long to ascertain +his situation, and watch well the progress of the case. Cases are known +where patients have been looked at by their advisers, stationed at the +door, where it was impossible to ascertain the expression of the +countenance, the condition of the tongue, the state of the skin, not to +say any thing of that of the pulse. + +We are acquainted with instances in which medical men have so acted +under the apprehension of taking infection, and where, too, they have +not felt they were doing any thing reprehensible, as was sufficiently +evident from the fact, that they themselves were the informants. + +These facts prove that injury has been done to the patient from +insufficient care; and cases are not wanting, where medical men +themselves have taken disease, where the circumstances of the case +warranted the belief that fear was the chief, if not the only cause. +Many very cunningly-devised plans have been recommended for the adoption +of the physicians visiting patients labouring under infectious diseases, +such as standing in a current of air passing between windows, or doors +and windows,—keeping a handkerchief applied to the mouth and nose, +washing the mouth with water, &c. These are sometimes adopted, yet there +is room to think that, where a man of merely ordinary fortitude supposes +that he inspires an atmosphere holding in solution a very virulent, nay +deadly poison, that he will be anxious to make his visit as short as +possible, even though the preventives above mentioned be religiously +adopted. + +Several of the cases of death among medical men, which have been +unhesitatingly attributed to infectious air, the Author is convinced, +from his knowledge of particular circumstances, and from the known +tendency of fear, have arisen from depression, in consequence of that +passion. + +The prejudicial operation of the doctrine of infectious air has been +proved in reference to the patient himself, _1st_, From his apprehension +for the safety of others ministering to him; _2d_, From the neglect and +desertion of friends and others; _3d_, From the insufficient medical +treatment which his case frequently obtains. + +It has been proved in reference to friends and attendants, who are often +in consequence in a state of apprehension, favouring the invasion of +disease; and in relation to the first, who are made to regard one of the +most delightful offices as a duty of imminent peril. + +It is hurtful both to patient and friend, by forbidding that intercourse +which, but for the danger in question, would be so delightful and +consoling to both. + +It tends to the commission of crimes of no trifling character, the +desertion of kindred and of friends, the hardening and debasing of the +heart, and the general corruption of the finest sentiments that bind and +ornament society. + +It has led to deeds not the least dark in the page of human history. + +It takes much from the efficiency of medicine, and has been the frequent +cause of much evil to its professors. + +For all those reasons, it is an important subject, and demands patient +investigation. + +Surely a case has been made out to shew how important are its effects, +and how much evil might be avoided were it proven, as is proposed to be +done, that Atmospheric Contagion has no existence. That is all, that is +desired to be shewn from what precedes, and we would on no account wish +the amount of mischief it inflicts to be thought as put forward as an +argument against its entity, which would be absurd. + + + + + CHAPTER II. + MEDICINE RETARDED—FORMS OF CONTAGION. + + +The progress of medical science has been much impeded by the operation +of the doctrine of atmospheric contagion. From the earliest periods the +practitioners of medicine have been in the habit of attributing a very +great proportion of the worst forms of disease to that agent; and the +consequence has been that little attention has been paid to the +investigation of the most difficult, and not the least important +department, that of the efficient and ordinary causes of disease. + +It was almost a necessary consequence of the possession of such an +instrument, ready on all occasions, to solve the problems offered by the +occurrences of disease, that no inquiry would be made into those +circumstances by which might be detected those influences that conduce +to its production. There was ever at hand an agent whose existence all +were alike ready to concede, which was amply sufficient to explain the +origin and propagation of pestilence. + +That being the case, medical men had no inducement to make +investigations, and from one generation to another they have gone on in +the old way, attributing much to that agency, and leaving uninquired +into, with few exceptions, the actual springs of diseased action. + +Until very lately little was known of the relation between disease and +such important matters as these,—the state of the atmosphere, the +severities of the weather, and its other contingent circumstances, the +quality of the food and drink, clothing, habits, climate, and the like. + +These most important matters received very little consideration, and +although much has lately been done to shew their influence in the origin +and propagation of disease; yet they are not regarded as so efficient in +that respect as they ought to be, and the reason of it is, that the +common application of atmospheric contagion to the explanation of the +problem, by the vast majority of medical practitioners, puts a stop to +the scrutiny which would detect their relation. The fact undoubtedly is, +that, in respect to some diseases, little is known, among those +intrusted with their treatment, of their causes. This situation of +affairs is dangerous, and were physicians to adopt the extravagant +measures, which the doctrine of atmospheric contagion suggests, there is +a risk that, armed with weapons of so powerful a nature as our medicines +are, and moreover, applied to so delicate and nicely strung a machine as +the human body, their interference might become downright tampering, and +dangerous in the extreme. + +But the blame does not lie so much with the present generation of +practitioners. It is more the fault of the science than of its present +professors. + +That doctrine has been taught them, as on established and well +authenticated principle. They have too readily confided in the accuracy +of their predecessors, and taken for ascertained, that which was only +supposititious. Still the public injury is the same, be that as it may; +and would the profession perform efficiently its important duties, and +deserve that confidence so necessary for the full operation of the art, +they would, without delay, inquire into the merits of this case, and +turn to the investigation of the causes of disease, the many facts and +principles, revealed by the late rapid progress of the sciences. + +For the judicious and efficient treatment of disease, a knowledge of its +causes is necessary. The disorders being ascertained, the first +consideration in reference to the treatment is the cause or causes, and +according as the information partakes of certainty or uncertainty, so +the propriety of the measures is sure or doubtful. + +Without a knowledge of the causes, sure or probable, our efforts are, in +some cases, like random blows made in the dark, they may or may not +strike the object. It is in general only when the causes are known, more +or less, particularly, that medical treatment can be said to rest on a +sure and philosophical basis, and to promise the full amount of benefit +the art can afford. + +For many years the investigation of Atmospheric Contagion has occupied +the Author, anxious only to ascertain its actual merits, and to be +guided by the result, free of prejudice or bias. + +The result has been, that from the actual, constant, and minute +observation of disease, from an enlarged inquiry into the circumstances +coincident therewith, of the pestilential character of many agencies, +and a careful comparison with every agent or form in nature with which +we are acquainted, bearing any resemblance to what Atmospheric Contagion +must be, if it have an existence at all; that where other hurtful +influences are operating, Atmospheric Contagion is needlessly called in +to account for their effects, and that it (_i. e._ Atmospheric +Contagion) has no existence, properly considered, in the light of an +atmosphere holding in solution a specific contagious poison. + +Before commencing the argument, it is proposed to notice shortly its +history, and the opinions held at this day respecting its nature and +qualities. + +But as these opinions are very various and conflicting, and as, +moreover, from the general confusion of terms, the reader will almost +unavoidably become perplexed and unable to understand the merits of the +case as treated here or by others, the Author proposes to explain, +before going further, what is meant or ought to be meant by contagion, +and by contagious air. He is not aware that any plain and uniform method +or arrangement of the principles in question is in common use, though +some physicians, as will appear in the historical sketch that is to +follow, have reduced contagion to two or three distinct kinds, and thus +divested the subject of much of its perplexing clashing of terms. They +have given fixed meanings to some terms formerly used by all, and even +at present by most, with too great latitude. + +We will consider, _1st_, Contagion. + +That term is, and with propriety may be, used to denote that property, +which matter eliminated in a body suffering under disease, has of +producing the same disease when applied to another in a state of health, +as the matter of small-pox. + +Contagion is also used, and will be employed here, to denote the matter +itself which we have just defined. + +Thus it appears that contagion is used to signify both the property of +the matter and the matter itself. This should be understood, as +confusion may lead to great misconception. In the same way, the term +“heat” is used to denote caloric itself, and also its property. + +Contagion, signifying the matter itself, is said to act in different +shapes, but here medical men divide. According to those on whose +authority most reliance is to be placed, they are the following—three in +number:— + +_1st_, By the direct application to the body of palpable contagious +matter. + +_2dly_, By the application to the body of clothes, and the like, +impregnated with contagious matter. + +_3dly_, By the application to the body of air holding in solution, +contagious matter. + +To contagion acting in the first-mentioned manner, has almost +universally been applied the title, by distinction, Contagion, or +immediate contagion; but in order to promote perspicuity, we shall call +it Contactual or Palpable Contagion. + +To contagion acting in the second-mentioned manner, has been applied the +term Fomites (impregnated clothes), but we shall call it Fomitic +Contagion. + +To contagion acting in the third-mentioned manner, many terms have been +applied indiscriminately, Contagion, Infection, Contagious Miasm, +Infectious Air, &c. &c.; but to preserve distinctness, and to shew its +relation to the other modes, we shall apply to it the title Atmospheric +Contagion. + +With Atmospheric Contagion, the third mode in which contagion acts, has +been confounded by many, air holding in solution, or having commingled +with it, gases or impurities, not producing exclusively one disease, as +contagious matter does; but productive of deranged health—or at least +hurtful to life. + +Air thus tainted, has also been called Contagious, Infectious, &c. &c.; +but as it is widely different, for the reason mentioned, they should not +be confounded; and in order to prevent any accidental confusion, we +shall term it vitiated, or, simply, impure air. + +There is yet another pestiferous principle called Marsh Miasm, which has +sometimes, but less frequently, been confounded with the third mode in +which contagion acts, viz. atmospheric contagion. They are very +different: the former is confined to marshy lands, and produces +exclusively disease of an intermittent character. + +Of the first mode in which contagion is said to act, contactual or +palpable contagion, there is the most positive proof. That is a settled +point capable of demonstration. + +Of the second, viz. fomitic contagion, there seems to be no good room to +doubt. It is consistent with our knowledge, on points of a like nature, +to admit the possibility of its existence; and there is evidence of +pretty good character, that contagion does act in that shape, though we +are disposed to think that it is not the cause of pestilence so often as +is generally understood. + +It is to the third mode, viz. atmospheric contagion, that we object. We +question its existence for these reasons, _first_, That in the whole +course of its history, it fails to supply us with sufficient evidence +thereof; _secondly_, That its supposed career is not marked with the +same uniformity of effect, and constancy of character, cognisable among +other powerful agents, but appears rather to be regulated by no fixed +laws; _thirdly_, That the phenomena of disease do not go to shew that it +is dependent on atmospheric contagion, the occurrence and dissemination +of which, moreover, it could not explain. + +We are further disposed to deny its existence at all, for this reason, +that its admission is opposed to the testimony of direct observation and +of experiments instituted for the purpose. + + + + + CHAPTER III. + HISTORICAL SKETCH. + + +In the Old Testament, frequent allusion is made to contagion, +particularly in Leviticus, where directions are given for the +expurgation, from the system, of that principle; for the isolation of +persons possessed of it; and the cleansing of garments therewith +infected. + +The earliest Grecian historians make reference to it, and Thucydides, in +his History of the Plague, attributes some occurrences in its career, to +the operation of that principle. + +Dr Winterbottom[1] writes thus, of an ancient physician—“Aratæus says, +that the miserable patients (those ill of Elephantiasis), were banished +into deserts, or to the top of mountains, where the kindness of their +friends occasionally attended their distresses; though perhaps they were +more frequently deserted.” + +Footnote 1: + + Dr Winterbottom on Sierra Leone. + +Cælius Aurelianus, a noted physician, says—“Some advise that a person +labouring under this disease, should be turned out of town, if a +stranger, or if an inhabitant, be banished to some distant part; others +advise the patient to be totally abandoned.” + +These expressions relate to contagion generally. + +Atmospheric contagion is not specified, though perhaps even then, it may +have been thought to exist. + +As already said, later physicians thought that contagious diseases were +propagated in three different ways, _1st_, by actual contact with the +matter or virus itself; _2dly_, by fomites, or by contact with clothes +tainted with it; and, _3dly_, by infection, or by air holding it in +solution. + +But it is to contagion, as diffused through the air, that the +observations that are to follow are directed. So we shall, for the +present at least, dismiss the other two modes of its action, that by +contact, and that by fomites or tainted clothes, with the expression of +our belief in their existence, as modes of the propagation of disease. + +In 1777, Dr Haygarth, an English physician, began to investigate the +laws that regulate the action of contagious poisons, and for the first +time they obtained a scientific examination, and became the subject of +experiment, if, perhaps, are excepted the labours of Lind, whose +observations appeared about the same time. + +Dr Haygarth believed in the propagation of disease through the direct +application of contagious matter, such, for instance, as that of +small-pox; but of this none have expressed any doubt worthy of notice; +for the fact is well known, and often witnessed, by inoculation for +small-pox and cow-pox. + +At the time at which Dr Haygarth wrote, very vague and extravagant +notions were held on the subject of contagious poisons diffused in the +air—of air holding in solution contagious poison, or, as we have +determined to call it—Atmospheric Contagion. + +It was believed to extend itself to great distances, and there to +develope its powers. + +His opinions on the subject were, at the time of their publication, +quite original; and as they are such as are usually held, to this day, +by most intelligent practitioners, the most important will be +transcribed here. + +In a letter to Dr Percival, on the prevention of infectious diseases, +published in 1801, Dr H. says—“I have long thought that there is no +subject on which a physician could employ his time and ability more +advantageously for the benefit of his fellow-creatures, than in the +investigation of febrile contagion, in order to ascertain the laws by +which it is communicated, and by what means it may be prevented. It is +well known to be the cause of very extensive destruction in the army, +the navy, and in large towns.” + +“In 1777 I began to ascertain, by clinical observations, (_i. e._ +observations made at the bedside of a patient,) according to what law +the small-pox infection, and, in 1780 and 1781, according to what law +the febrile infection, is propagated.”—“I found that the pernicious +effects of small-pox miasms (that is, airs or vapours) were limited to a +very narrow sphere. In the open air, and in moderate cases, I discovered +that the infectious distance does not exceed half a yard.”—“Hence it is +probable that, even when the distemper is malignant, the infectious +influence extends to but a few yards from the poison.”—“I soon also +discovered, that the contagion of fevers was confined to a much narrower +sphere.” + +“You will recollect, my dear friend, that at this time (1781) my +attention was much engaged in the investigation of the nature of the +small-pox poison. I was struck with the difference of the periods in +those two maladies during which the infection remains in a latent state, +that is, the interval of time which elapses between the patient’s +exposure to the pestilential influence and the commencement of the +fever. In the typhus, this period appeared to be much longer than in +small-pox.” + +The period between the exposure to what is considered infection, and the +period of the manifestation of disease, certainly does vary in different +distempers. In those in which palpable contagious poisons are produced, +and where they are palpably applied to the system, the interval is +known, and seldom varies; but in those where a palpable poison is not +recognised, or where it is said to act exclusively through the air, it +is found that the interval is sometimes short, sometimes long, and +manifests none of that precision almost always observed in reference to +the first class of diseases. + +Dr Haygarth again says, “When the room of a patient ill of an infectious +fever is spacious, airy, and clean, few or none of the most intimate +attendants will catch the disease.” + +“Among the middle and higher ranks of society in Chester and its +neighbourhood, during a period of thirty-one years, I scarcely recollect +a single instance of the typhus fever being communicated to a second +person, not even during the epidemics of 1783 and 1786, which excited a +general alarm in that city, Fresh air and cleanliness were the only +means which I employed to prevent infection. Doors and windows were kept +open as far as the season, and other circumstances, would permit. +Curtains were drawn to exclude the light, but not the free circulation +of air. All clothes, utensils, &c. used by the patient were immersed in +a vessel of cold water immediately, and, when taken out of it, carefully +washed. The floors were kept clean, and vinegar was sometimes, but not +always, employed to sprinkle. It was thought to be more easy to remove +than to correct the poison.” + +Dr Haygarth deserves much credit for his judicious treatment, and by it +he had the satisfaction of seeing much public good effected. His +principles are yet acted upon with the very best effects; but it will be +shewn, at a more advanced part of this work, that the check put to the +progress of disease, was rather to be attributed to the removal of an +atmosphere loaded with unwholesome emanations, than to any power those +steps or measures had, of rendering innocuous, by dilution, a specific +contagious poison. + +Dr Haygarth continues—“The whole evidence which I have been able to +collect, incontestibly leads to this very important conclusion, that +febrile infection extends but to a very narrow sphere from the person. + +“It appears highly improbable that the typhus infection should ever be +communicated in the open air, by the common intercourse of society; +because visitors, and even attendants, with very few exceptions, escape +the fever, when exposed to it, in even the same chamber, if clean, airy, +and spacious. + +“The quantity of miasms (unwholesome or poisonous air) respired in the +latter, is incomparably more than it can be in the former situation. It +is not, however, intended to be asserted that such an event is +impossible, if a person on purpose, or by some rare accident, were to +breathe the air which immediately issues from a patient, or from clothes +fully impregnated with the poison. + +“During my long attention to this inquiry, not a single instance ever +occurred to prove that persons liable to the small-pox could associate +in the same chamber with a patient in the distemper, without receiving +the infection. + +“We have no certain knowledge in what manner infectious fevers are +received into the body. According to the most plausible conjecture they +appear to be communicated by poisonous vapours, which issue from the +breath, or the insensible perspiration, or the excretions of a patient +in the distemper. These miasms are probably taken into the body by the +absorbents of the mouth, nostrils, lungs, stomach, or skin.” + +Under the able investigation of Dr Haygarth, the doctrine of infection +has been deprived of much of its extravagant character. Under his +examination it is found losing that widely extended range of action, and +that extreme virulence, that had hitherto marked its history. + +Dr Bateman, in his excellent work on contagious fever, after alluding to +a prevalent opinion, that contagious poison is capable of diffusion in +the air, says, “To one acquainted with the evidence which has been +adduced relative to the properties of contagion, these opinions, and the +terrors connected with them, appear equally unfounded and absurd, as are +all creations of an over-excited imagination magnified by prejudice and +alarm—for it has been proved, beyond the possibility of a doubt, by the +concurrent testimony of a multitude of the ablest practitioners, who +have had every opportunity of investigating the fact, and by all the +experience which the establishment of fever boards and houses of +recovery has afforded the means of accumulating, that no contagion +whatever is communicable, even to the distance of a few feet, through +the medium of the free and open atmosphere, and consequently that +residence in a district where fever prevails is free from all danger. +Nay, it has been further proved on the same undeniable evidence, that +the house and even the apartment, occupied by the sick, may be rendered +perfectly innocuous, the contagion being disarmed of its activity and +virulence by dilution with pure air,” &c. + +Dr Bateman gives the following facts— + +“All the patients admitted into the London House of Recovery are +transported in a litter by two others employed by the institution, +enveloped in their uncleanly and tainted apparel. Yet the porters who +have been daily occupied for the last eighteen months in conveying this +double source of contagion, often the distance of two or three miles, +and assisting them in and out of the litter, have never received the +infection. + +“Neither have the washerwomen, employed during the period of my +attendance, (sixteen years) on the House of Recovery, occupied almost +constantly in washing the apparel brought in by the patient, as well as +the bed-linen, often much soiled by their excretions, and the cloths +used by the patients in the house, ever been affected with the fever.” + +Dr Patrick Russell, whose work on the plague is so well known, is the +next writer to whose observations reference will be made. His personal +observation of much contagious disease, and his high character, entitle +his observations to much weight. They will amply shew, how the question +before us has gained with the advancement of medical science. Some are +subjoined. + +“In the first place, the various and vague application of the term +contagion has been the source of confusion. In foreign languages, as +well as in English, it has sometimes been used for the plague itself, +sometimes as synonimous with infections; sometimes for the virulent +effluvia issuing from the sick, or from substances infected, and +sometimes as a property common to various diseases.” + +He is of the decided opinion, that plague is communicated, by contact of +the body, with the poison, which is properly understood by the word +contagion. He says—“The second mode of contagion is by the medium of the +air. The effluvia arising from the diseased, received into the ambient +air, form a pestiferous atmosphere, more or less impregnated with these +effluvia, as it recedes from their source. That contagion is thus +communicated in the chamber of the sick, appears from persons being +infected without touching the diseased body, or any thing in the room +that may be supposed to harbour infection. + +“To what distance the tainted atmosphere extends is not yet known, but +recent facts render it probable that the effluvia, when once transmitted +into the air, are soon dispersed, blended with the common mass, or +otherwise suffer such alteration as render them innocuous at no great +distance from their source. It is probable, also, that those effluvia +arise, in an active state, to no great height in the atmosphere.” + +He adds, that the contagion by fomites, that is, impregnated clothes, is +the most extensive in its operation; and that it spreads disease, not +only in all quarters of a town, but also to remote regions. He asserts +that the plague is conveyed into different streets, remote from one +another, by the Jewish salesmen, and that he has known Armenian +washerwomen infected by tainted linen. The infectious air of plague, +according to him, when it adheres to substances not exposed to free +ventilation, and closely packed, retains its vigour for along time, and +in that state is transported to other countries: and he held it as +proven that it retains its activity in a three months’ voyage from the +coast of Syria to Marseilles. + +He is disposed to think that the contagion of plague, rarely remains in +the system longer than ten days, and that more danger is to be +apprehended from the baggage of passengers who enter into lazarettoes, +than from their persons. + +To Dr Joseph Adams we are indebted for an excellent treatise on animal +poisons, one that is much valued for the information and clear views it +contains. The following is an extract from the work in question. + +“By contagion I would understand those diseases with the origin of which +we are now unacquainted, but which at present can only be propagated by +contact with a person, or matter from a person under similar disease. +Contagious diseases, which it is now our business to consider, may be +divided into chronic and acute, of the former are the itch, and several +others. These are for the most part incurable by the unassisted powers +of the constitution. The acute of which are the small-pox, and many +other exanthemata, (these are those diseases accompanied with fever) +marked with a peculiar eruption, and that attack only once, such as +measles, and scarlet fever produce a critical fever, which ceases with +the disease. + +“The chronic may attack a person as often as he is exposed to the +exciting cause, the acute, for the most part, leave the constitution no +longer susceptible of their operation.” + +After pointing out the modes of communication of contagious diseases by +contact and by fomites, he says, “Infectious diseases, on the contrary, +may be traced in their origin, and do not require for their production +matter similar to their effects, but may at any time be generated by +crowding together the sick or wounded of any description. Of this kind +are the hospital, prison, or ship-fever, camp dysentery, and some +peculiarly malignant ulcers. Though these diseases, when formed, may +produce their like in others, yet we can always trace their origin to +causes different from their effects.” + +From the London Cyclopædia the following extract is taken. + +“There does not appear to be any distinction commonly made between +contagious and infectious diseases.” + +This extract proves how much confusion there exists, with the terms +infectious and contagious. Here they are said to be used synonimously, +and in that of Dr Bateman just quoted, a great distinction is drawn. + +Such are a few of the facts connected with the history of contagion, +which are most worthy of notice, in a work of this kind. + +This sketch will afford some idea of the most rational views which have +been, and still are, held on the subject; and of the light in which it +is at present regarded by the medical world. + +It is feared that the extracts which have been given, may appear too +copious, but it has been thought highly proper, that the opinions of +those justly considered, the greatest authorities on the subject, should +be given: and that they might not be misunderstood, they have been, for +the most part, presented verbatim. + + + + + CHAPTER IV. + THE ABSENCE OF SUFFICIENT EVIDENCE OF THE EXISTENCE OF ATMOSPHERIC + CONTAGION. + + + Ponderable bodies are endowed with common or general properties, and + likewise with particular or secondary properties. + + MAGENDIE. + + +The properties of atmospheric contagion, under its various titles, have +been noted in the preceding chapter. They have been attributed to it, by +the most eminent writers on the subject, and are such as are assented +to, by most medical men of the present day. + +Its origin, the sphere of its activity, and the means by which it may be +destroyed or neutralized, have there been alluded to. In the extracts +given, and in the current medical literature of the present time, it is +spoken of, as an agent of whose existence there is the utmost assurance. + +The reader who has not already thought upon the subject for himself, but +has, as is almost universally done, in reference to this agent, taken +the whole case, as one fully ascertained, and settled upon fixed +principles, will doubtless be surprised to hear, that it is the decided +opinion of a member of the medical profession, that the doctrine of +atmospheric contagion presents no sufficient evidence of its truth; that +he is in possession of facts connected with the occurrence of disease, +which render it probable, that other and efficient causes of disease +have been thrown aside, to make room for that agency, and that he is +convinced, from the results of experiments on contagious poisons, and +from a minute inquiry into their nature, that it (that is, atmospheric +contagion) does not exist. Perhaps he should regret that he has not been +able to see the question in the same light as his brethren. He has felt +unwilling to espouse singular opinions; he has therefore been patient in +the inquiry, and it has been only from the consideration, that a great +medical truth was concerned, that the progress of the science might +possibly, thereby, be promoted, and that the comfort of the patient, and +the ease of mind, of the public, might be advanced, that he has been +induced to lay his opinions before the world. + + +Regarded as a physical agent, atmospheric contagion has never been +detected, and its presence has been inferred merely from the observation +of what have been supposed its effects. It has certainly never been +unequivocally manifested to any of the external senses. It has never +been seen combined with the atmosphere, precipitated from it, or +attracted therefrom, to solid bodies. + +It might be supposed, however, from common parlance, that it has often +made itself known to the sense of smell; but while nothing certainly +proves that the impressions made on the nasal organ arise from +atmospheric contagion, many circumstances induce at once the belief, +that they proceed from common impurities. + +The atmosphere in a sick chamber sometimes certainly has an odour, but +it is certainly more logical to attribute this to the presence of +impurities, whose presence there is no room to doubt, than to an agent +whose existence under any circumstances has never been proven. + +Had contagious matter the power of diffusing an odour through the air, +it is probable, that would be constantly the same, in all cases of the +same disease, and that each disease would have its own peculiar odour: +but this correspondence is not found. + +It is not desired to prove, that atmospheric contagion does not exist, +because it cannot be detected by the senses. + +Many agencies exist, which, under ordinary circumstances, are beyond the +cognizance of the external senses; but in general they make themselves +manifest to one, or other, under some conditions. The electricity of the +air is neither seen nor felt under ordinary circumstances; but that +agent is capable of being collected from the atmosphere in such +quantities as are cognizable to the eye. Now, under any manner of +circumstances, contagion has never been recognised by the senses—and it +has never been detected by chemical experiments. + +It is surely not unfair to expect, that, if a contagious poison, a +palpable matter such as is contained in a small-pox pustule, is +transformed to the vaporic state, or taken into the atmosphere, that the +air so impregnated will be marked by some qualities, beyond those of +simple, pure air. Perhaps air in which it is disseminated should have an +odour, and perhaps that odour should be of a peculiar kind, in each +disease. Should it not also be marked by some effects, constant and +uniform, upon the human body, such as mark the career of such like +agents in a palpable form, when applied either immediately, as by touch, +or mediately, as by fomites? Perhaps it may not be deemed unreasonable +to expect, that atmospheric contagion, did it exist, would produce its +peculiar effects, as constantly, or nearly so, as a palpable contagious +poison. But how different is the fact. If a hundred persons not formerly +vaccinated, have the palpable contagion of cow-pox matter inserted under +the skin, the probability is, that, if the matter is good, and the +operation is skilfully done, 90 or 95 will be duly affected with the +specific effects; whereas, when a hundred persons are exposed to the +atmosphere of fever, and when these persons, too, have not before had +the disease, perhaps not one, or at most not above two or three will +take the distemper, unless the air has become extremely vitiated; and +then the probability is, that it is so, not in consequence of the +presence of specific contagious virus, but of gross impurities, and the +consumption of the more vital parts, as in the case of the Black Hole of +Calcutta, where putrid fever attacked all who survived their +confinement, certainly not from the action of contagious poison. + + + + + CHAPTER V. + CONTAGIOUS POISONS—NON-SOLUTION IN THE AIR—RESULTS OF EXPERIMENTS. + + + Animal substances are the results of still more delicate processes, + and of a more refined organization (than vegetables); and the balance + of affinities, by which they exist, is disturbed by still slighter + causes. + + HENRY. + + +For the present, the argument drawn from the actual observation of the +origin and propagation of disease, against the doctrine of atmospheric +contagion, will be waived, and it is proposed here, before going +farther, to inquire, whether the case may not be settled by a reference +to the history of analogous agents, and to the results of experiment. + +It is proposed here to inquire if it is likely, judging from their +chemical constitution, that palpable contagious poisons, such as the +matter of small-pox, may be disseminated through the air, without +chemical changes being effected upon them, that must be destructive of +their peculiar properties. + +The palpable contagious poisons are products of the blood, formed +therefrom, by the nicest processes. They partake of the nature common to +all animal products; are, like them, prone to putrefaction,—and, like +them, are of a very compound nature. + +They are animal products: now it is a well known fact that almost all +animal products are fixed—that is, incapable of being volatilized or +disseminated in air, unchanged in chemical constitution. + +Gelatin or animal jelly; albumen, or what is much the same, the white +part of an egg; fibrin or muscular fibre, and the like, are never known +to be in the vaporic state, or commingled with the air. They are +incapable of assuming the aeriform state, not in virtue of a character +peculiar to them, but on account of that nature they share in common +with almost all animal principles, which precludes the possibility of +their being volatilized. No experiment has ever been made which can show +that the principles specified may be diffused through the air. + +When exposed to the air for even a short period, decomposition takes +place, and their original nature is totally subverted. + +Their elements are held together by affinities too feeble to admit of +their particles being separated by air, without new combinations being +formed. + +If heat be applied to them, immediate destruction takes place; if they +be kept moist, and in merely a moderate temperature, putrefaction or +fermentation, in the proper sense of the terms, occurs; if carefully +dried and exposed to the atmosphere, they remain little altered, for a +considerable time; but at length fundamental changes, though operating +slowly, entirely change their nature. + +It cannot be shewn that contagious poisons are less animalized than the +products alluded to. + +Is it ascertained that contagious poisons, unlike other proximate animal +principles, enter into the aeriform state? + +Putting aside the loose and rash statements current upon the subject, as +unworthy of notice, there can be no doubt that, in the whole history of +those poisons, no fact is known, that can legitimately be held as +proving, that they possess such a property, or of giving the idea any +degree of countenance. + +On the other hand, many facts are known, which are adequate for the +refutation of these statements, and that are sufficient to put the case +beyond a doubt. + +Small-pox propagates by a contagious poison, eliminated from the blood, +and found in the pox or pustule. + +It is known to every one that it affects, by contact, hence the practice +of inoculation, which is nothing more than the inserting, under the +skin, a little of that agent, a practice which has been in use among the +negroes of Africa, since, or before, the introduction of the doctrines +of Mahomet. + +Many physicians, perhaps almost all, believe that it, the poison, may be +diffused through the air, and in that situation produce its wonted +effects; but evidence is submitted to shew, how questionable that is: +and it is conclusive, as far as negative evidence can go. + +The following experiment was performed by Dr O’Ryan of Lyons.[2] The +force of its results, and their tendency, cannot be overlooked. + +Footnote 2: + + O’Ryan, Sur les Fievres. + +“A dish containing lint saturated with matter taken from the natural and +the inoculated small-pox, was placed upon a table, whose diameter was +three feet, and children who never had the disease, and never were +inoculated or vaccinated, were placed around it, and kept there for some +considerable time; yet none of them were seized with the disease.” + +“He also exposed children within two feet of a child affected at the +time with the inoculated small-pox, for an hour daily, for fourteen +days. None of the children were affected, and all were successfully +inoculated two months afterwards.” + +We are acquainted, too, with many cases of small-pox, where the houses +in which they were, were visited by many persons, some of whom had not +been vaccinated, or inoculated, and yet the disease did not spread to +them; and in those instances, where the distemper did spread, only some, +and not all, who were liable, were affected, as would have been the +case, had the matter been inserted under the skin. + +Perhaps, in reference to this contagious matter and to others, it may be +said that they were not favourably situated for acting. Heat, moisture, +and the passing to and fro, of air, must certainly assist the assumption +of the aeriform state; and a more favourable opportunity cannot be +obtained, than the contagious matter of small-pox pustules has, in the +mouth of the patient, where it almost always is observed. That situation +is perhaps even more favourable than that of the matter operated on by +Dr O’Ryan. Yet it is known, (and we are prepared to shew cases) that +persons liable to the disease have breathed in the same apartment, and +have not taken the distemper. We know, too, of many cases, where persons +have been attacked under such circumstances, but that has probably +arisen from actual contact with the matter, or exposure to those general +and widely-spread influences productive of that pestilence, that +undoubtedly exist. But it is not necessary for our purpose, that all +should escape, but, that any should not suffer. It is enough that those +who escape, are more, in proportion, than those who resist the action of +the palpable poison, when inserted into the system by inoculation. + +With respect, also, to the disease produced by the insertion of cow-pox +matter, or, in other words, by vaccination, as it is called; nobody ever +heard of it being propagated through the air. It is feared that it would +be a very inefficient mode of vaccinating, to bring the child to be +vaccinated, into an atmosphere, to which was exposed an arm with a +cow-pox. He who would propose such a plan would be laughed at by every +old woman; and what is held as so absurd and ridiculous in respect to +cow-pox, cannot be very wise in reference to small-pox, plague, scarlet +fever, and the like. There are other diseases, too, which undoubtedly +are propagated by palpable contagious poisons. Yet were any person +affected with them, to whisper, that a contagious atmosphere had been +the occasion, they would be held as using no small liberty with the +credulity of the medical adviser. + +There is yet another palpable contagious matter to which reference must +be made,—that of itch. The only known way by which that disease can be +propagated, from one to another, is by palpable or contactual contagion. + +Many medical men are in the daily practice of seeing and examining such +cases, yet they seldom or never are affected with it. Any caution +directed against the operation of that contagion, is addressed +exclusively to contact, never to the atmosphere. + +The plague, according to the very best authorities, is undoubtedly +marked by the elimination of a matter capable of producing the same +pestilence, when applied in a palpable form, to the body of another. The +plague has been produced intentionally by inoculation, and may be +propagated at pleasure. + +Dr Patrick Russell was satisfied, from the observation of much of that +pestilence, that the atmospheric contagion did not extend the distance +of four feet; and there is much room to think that, if he had extended +his inquiry farther, that had he been aware how unusual it is for a +proximate animal principle, as contagious matter, to take on the +aeriform state, he would have arrived at the conclusion, that it did not +only not exist, at the distance of four feet from the patient, but that +it did not exist at all. Had he gone that length, he would not have +created any more difficulties, to be explained away, than were made by +laying down for it, such a limited range of operation, for there would, +it seems, be little difficulty, in general, in discovering, that persons +who had approached so near as four feet to the patient, had come in +contact either with the sick himself, or the matter of the sores +attached to clothes or other bodies. + +We know of no facts capable of proving that the matter of plague is +diffusible through the air; and the very evidence of Dr Russell, which +was used by him to prove the limited range of atmospheric contagion, may +be used to lend countenance to the position, that it does not exist at +all. + +The evidence was this:—Dr Russell was in the practice, at Aleppo, of +examining plague sores from a window four feet from the patient, yet he +suffered not from that pestilence. + +Scarlet Fever is a disease universally held to be one of those +propagated by a contagious principle. + +It is commonly believed that a contagious poison is eliminated in the +course of this disease, similar to that of small-pox. + +Its history is marked by this remarkable feature, peculiar to acute +contagious diseases, of attacking the same individual only once; and the +disease is accompanied by a peculiar eruption, which may, without +impropriety, be supposed to contain the said contagious poison. This +eruption is uniform in the time of its appearance, its duration, and +decay, like the other eruptions of other contagious diseases. On all +these accounts, the Author is disposed to assent to its possession of +the contagious poison;—and that will be taken for granted. + +Connected with this view, is an observation made by Dr Sidey, of +Edinburgh, in a paper contained in a late Number of the Edinburgh +Medical and Surgical Journal, on Scarlatina, as lately prevalent in that +town. It is to this effect, that he found that the disease, when +characterized by a distinct eruption, attacked several members of a +family more frequently, than when it wanted that symptom. + +We will inquire whether persons exposed to an atmosphere containing one +sick of that disease, take that distemper as uniformly, as those take +the respective diseases of those palpable contagious poisons which may +be inserted under the skin. + +During a most severe and mortal visitation of that disease in Tranent +and its surrounding country, which lasted from about the end of January +to the 20th October 1836, many cases occurred, where brothers and +sisters of children suffering under that malady, living in the same +apartment, but not sleeping together, remained free of any attack +whatever at the time. + +Had the poison been capable of diffusion in the atmosphere, the air +would have become highly contagious, and as persons were constantly +inhaling it, and among them some liable to the disease, it would +certainly have manifested its peculiar pestiferous influence upon them. + +But the result was different, and the person exposed at that time +remained quite free of it; and in the course of time, varying from weeks +to several months after, went through the disease in the ordinary +manner. These cases have been carefully noted and preserved. + +But the Author was anxious to ascertain, by other means, whether that +disease was capable of propagation by atmospheric contagion; and +opportunities were not wanting. + +It occurred that the matter of ulcers, in the throat, might possibly +contain the contagious poison, and might be made the subject of +experiment. + +The following is a case in which the experiment was made. + +The patient, a boy eight years old, had been exposed about three months +before, constantly, to an atmosphere in which a younger brother, ill of +scarlet fever, was breathing. + +He had the precursory fever, and the tonsils and uvula (the parts at the +back of the mouth) were almost covered with ash-coloured spots and +suppurating ulcers. + +A piece of linen, fixed to the extremity of a probe, was rubbed freely +over the ulcers. The linen impregnated with matter and the secretions, +was, within an hour or two of its being taken, exposed to the free +action of the air of a small apartment, where it remained for ten days, +without producing any effect, upon several persons, a good deal in the +room; and among them, two children, one aged two, and the other fourteen +years, who had not had scarlet fever. They respired the air occasionally +and for a considerable time, on the several days. + +The temperature was various. During the day being about 60° Fahr., and +40° during the night. The linen readily became dry, but was repeatedly +moistened with water. + +This experiment goes to shew, that the matter of the ulcers of scarlet +fever is incapable of propagating the disease, through the medium of the +air. + +But scarcely any better nidus could be formed, for the dissemination of +the matter, of the ulcers, through the atmosphere, than the sores +themselves, the very place where it is eliminated; and cases have been +referred to, where persons have respired an atmosphere thus liable to be +acted on, with the most complete impunity. + +It is not ascertained that the contagious poison is eliminated at the +sores in the throat, but such seems probable, seeing that the sores are +as essential and constant as the eruption itself. + +Experiments might have been multiplied, but that has appeared +unnecessary, as it is hoped that enough has been done to shew that the +contagious poisons which have undergone our examination, are incapable +of assuming the aeriform state, and, as it must seem probable, that in a +point so important, they will all coincide, even those which have not +been treated of here. + +Their chemical constitution, as before remarked, prevents their assuming +that state. Dr Henry of Manchester remarks, when pointing out the +distinctive characters of animal and vegetable bodies, that “Animal +substances are the results of still more delicate processes, and of a +more refined organization, and the balance of affinities by which they +exist is disturbed by still slighter causes;” and again says, “Instead +of passing through the vinous and the acetous fermentation, they are +peculiarly prone to undergo putrefaction.” + +Thus, then, this great law, ascertained and settled beyond a doubt, and +the results of our observations on the causes of diseases styled +contagious, and of experiments on the palpable contagious poisons +themselves, are opposed to the admission of this doctrine, and when we +recall to memory the slender evidence, nay, the absence of any evidence +at all, the conclusion almost necessarily is, that atmospheric contagion +does not, and cannot exist. + +With what justice may we now join with De Lolme, when he says—“There is +a very essential consideration to be made in every science, though +speculators are very apt to lose sight of it, which is, that in order +that things may have existence, that they must be possible.” + + + + + CHAPTER VII. + CONTAGIOUS POISONS, COMPARED WITH YEAST—DOES THAT AGENT ASSUME THE + AERIFORM STATE? + + +Lest the evidence we have laid before the reader should not be so +satisfactory and conclusive as it has been deemed by us, the details and +results of some investigation into yeast will now be given. + +It occurred to us, that it would be useful, in our inquiry respecting +contagious poisons, to ascertain whether or not yeast was capable of +producing its wonted effects through the medium of the air, if, in +short, it was capable of taking on the vaporic state. We were led to +this inquiry from the consideration, that it and contagious poisons +presented points of resemblance of the most important nature, and that +the history of the one might elucidate that of the others. + +Yeast is the only other inanimate substance, besides the contagious +poisons, with which we are acquainted, which has the property of +producing a substance in every respect like itself, in short, of +reproduction. + +Like the contagious poisons, too, it is the result of a great and active +process, which, like them, it can again produce in other materials. + +Fermentation may be likened to contagious disease, and, indeed, it is +not the first time contagious disease has been likened to fermentation. +These diseases produce contagious poisons,—fermentation produces yeast, +and again, these agents produce their respective processes. + +Bodies in general, which have undergone the action at least of the +active contagious poisons, are not liable to be again affected by them; +so vegetable bodies, which have undergone fermentation, by means of +yeast, are not liable to be again acted upon by a second application. + +It is important to know if yeast is capable of assuming the aeriform +state. + +It is a complex substance, being compound in its chemical constitution. +Did we find that it was, then it might seem probable that contagious +poisons (putting out of consideration the evidence already given), might +possibly be so disseminated also. It runs readily into putrefaction, and +in a short time loses its power of producing its peculiar effects, that +is, fermentation. + +Knowing this, we were inclined to believe that it could not get into the +atmosphere otherwise than in a decomposed state, and, therefore, could +not act through that medium. + +The question was put to a most intelligent brewer, conversant with its +common qualities, and the unhesitating answer was immediately given, +that it could act through the air. + +Here we could not help marking the striking similarity in the bearing of +the brewer, with the confidence with which medical men speak of the like +property of contagious poisons—the marked taking for granted _what_ was +opposed in both instances, to the obvious evidence of chemistry, and +_what_ might be so readily tested by experiment. + +He was of opinion, that if fermentation were going on in a tub in an +apartment where there was a quantity of wort (liquid ready for +fermentation), to which no yeast had been added, that that process would +be excited from the yeast in the fermenting tub, producing its influence +through the medium of the atmosphere, in short, by being dissolved in +it. + +As that opinion did not tally with our opinions on chemical affinity, +recourse was had to experiment. + + + _1st_ EXPERIMENT. + +A quantity of wort, to which no yeast had been added, was put into a +wide mouthed vessel, and suspended in the mouth of a large tub, +containing ale in an active state of fermentation. The vessel was +allowed to remain three days, and at the end of that time no more +appearance of fermentation was detected, than a very slight display of +frothy bubbles in the middle, nothing more than we were assured by the +brewer, was wont to appear from spontaneous fermentation. + +A blind devotion to his opinion might have induced the brewer to +attribute to the yeast acting through the medium of the air, what was +quite spontaneous, and if he had done so, how like his case would have +been to that of some medical men, who unwittingly attribute to +atmospheric contagion, what is spontaneous or dependent on other +agencies. + +From this experiment it appears that yeast is incapable of solution in +the air, and of producing through that medium its peculiar effects. + +But to make the result still more certain, another experiment was +performed. + + + _2d_ EXPERIMENT. + +A wide mouthed vessel, containing a quantity of water, was suspended +over some liquor, in a state of active fermentation, for the purpose of +absorbing any gas or yeast, in a state of vapour proceeding from it. It +was kept there two days, and then examined. Its taste was somewhat +altered, and it had acquired a slight odour much resembling that of +yeast, probably from the absorption of gas. It was thought, that if this +water had become impregnated with yeast, that that circumstance would be +rendered manifest, by producing fermentation, when added to a quantity +of wort; and to determine the question, the following trial was made. + +Two jugs half filled with wort, free from yeast, were placed in an +apartment whose atmosphere was favourable to fermentation. To one was +added the water which had been suspended over the fermenting tub, and to +the other an equal quantity of pure water. They were then put aside, and +secured from interference. At the end of three days they were examined. +The wort to which had been added the water taken from over the +fermenting tub, presented on its surface a few frothy bubbles, but not +the slightest appearance of yeast. + +The wort, to which pure water had been added, presented an appearance +identically the same, having a few frothy bubbles on its surface, but +not any other, the most trifling sign of fermentation. + +Similar experiments were made at a distillery, where the facilities for +their success were said to be even greater than at the brewery, and they +were marked with precisely similar results. + +Thus, then, it appears, as the result of experiment, that yeast is +incapable of assuming the vaporic or aeriform state. + +This inquiry will perhaps appear to many remote and unconnected with the +proper subject of these pages, and, hence, that it is altogether +superfluous; but we think differently, and are of opinion, that an +accurate knowledge of that agent is calculated to be of the utmost use +in forwarding the formation of a just estimate of the habitudes of the +contagious poisons, which it resembles in several very important points. + +It is, as before stated, the only other substance belonging to the +inanimate world, whose immediate and most prominent property is that of +propagating a substance identically the same—of producing, through a +peculiar and uniform process, an agent possessed again of all its +properties. + +Some other agents may be said, under some circumstances, to propagate +themselves, but it is in a very remote way, and by no means by that +direct and uniform operation which marks the propagation of contagious +poisons and yeast, which is obviously as well defined as germination +among animal and vegetable bodies. + +_Heat_, under some circumstances, does cause the production or evolution +of heat, but that is rather an accidental circumstance, brought about +remotely by the chemical operation produced, and would have taken place +whatever had been the cause of that process, and is not the result of an +immediate and particular property. + +Vitiated air also is calculated much in the same way to reproduce +itself; but, instead of being in virtue of a quality possessed by the +palpable contagious poisons, vitiated air of itself produces disease, +and a common result of disease is vitiated or impure air. + +The close analogy subsisting between yeast and the palpable contagious +poisons, it is hoped, has been fully made out; and though it is not +permitted, by the rules of logic, positively to determine, that the laws +which regulate the action of the one, necessarily hold with the other +agents; yet, where there is no evidence of a contrary nature, the +closeness of the connection lends countenance to the idea. + +That analogy seems remarkably strong when it is considered, that both +yeast and the palpable contagious poisons produce their peculiar effects +only once upon the same object. + +Many instances are known where the palpable contagious poisons have +produced their peculiar effects more than once, but these deserve rather +to be held as exceptions to the general law than as a proof against its +existence. + + + + + PART II. + + + + + CHAPTER I. + THE NEGATION OF ATMOSPHERIC CONTAGION FROM THE HISTORY AND ACTUAL + OBSERVATION OF DISEASE. + + + Ce qu’il y’a d’extraordinaire c’est que ceux qui fatiguent leur raison + pour lui faire rapporter de certains événements à des vertus occultes + n’ont pas un moindre effort à faire pour s’empêcher d’en voir la + véritable cause. + + MONTESQUIEU. + + +It has been attempted, in the preceding part of this work, to prove, on +general principles, and by a reference to analogous objects, that +atmospheric contagion cannot exist; but, lest that object should appear +unaccomplished, and that the data are insufficient for the conclusion +proposed, it is purposed to test the merits of the question by the +consideration of the history and phenomena of disease. + +Those circumstances, connected with the appearance and propagation of +disease, on which the doctrine of atmospheric contagion rests, will be +inquired into, and their weight and importance duly ascertained. This +inquiry will be prosecuted as if no such investigation as the preceding +had been made, and as if the existence of that agency was not +irreconcilable with well ascertained laws; and, for the sake of +argument, the possibility of its existence will be conceded. + +The facts in the history of disease, which are held as lending +countenance to the doctrine of atmospheric contagion—of proving its +existence, are, chiefly, the general prevalence of disease at one and +the same time among the members of the same family, of the inhabitants +of the same town, district, and country,—its affecting the visitors and +attendants of the sick,—and its observation in places hitherto healthy, +shortly after communication with those ravaged with the distemper. These +facts cannot be denied; and all that can be done is to weigh their +value, as proofs of the existence of atmospheric contagion, and the +first mentioned will occupy our attention. + + +THE EVIDENCE DRAWN FROM THE WIDELY SPREAD AND SIMULTANEOUS PREVALENCE OF + DISEASE, IN FAVOUR OF ATMOSPHERIC CONTAGION, CONSIDERED. + +The widely-spread prevalence of disease at the same time among the +inhabitants of a country or district, is almost invariably held as +affording proof of the presence and operation of atmospheric contagion. + +The ravages of pestilence, rapid, wide, and deadly, are noticed in the +histories of all nations, and at intervals they have been experienced +during the long period of the existence of the world; and the +destruction of whole armies, and the annihilation of entire nations, +prove how widely spread its operation has sometimes been. + +Did the circumstance of disease being widely spread prove its +propagation by atmospheric contagion, then the matter were at rest; but +the propriety of such an inference is questionable. + +Let it be supposed that there is prevailing, in a district of country, +disease to a great amount, that is to say, many cases of the same +distemper. + +That single circumstance proves nothing in reference to atmospheric +contagion, more than to any other probable cause of disease. It shews, +merely, that there is in wide operation some cause or causes of +sickness; and it is totally unwarrantable to conclude that one agency, +more than another, is the efficient cause, without further information +directly bearing on the subject. + +It is with the knowledge of the single fact, and in total ignorance of +others, or with total blindness to them, that atmospheric contagion is +pronounced to be the active agent. + +Now it is not the peculiar property, the exclusive prerogative of that +principle, to cause disease; at least, that character has not been +openly sought by its advocates, though the tone of common conversation, +and of medical writings on the subject, would seem to imply that it had +been tacitly granted. + +That cannot be conceded. Many other agencies are known to be productive +of sickness, and have, on many occasions, induced pestilence of a deadly +character, that has ravaged in no despicable limits. + +The isolated fact itself of disease being widely extended in the absence +of particulars, after proving that some cause existed, should +legitimately go to create a suspicion, that the cause or causes which +had produced the first cases, and acted as the ordinary springs of the +malady, were continuing to operate on other individuals. Such would be +known to be capable of producing the effect observed, for the +satisfactory reason, that it or they had already accomplished it. How +much more wise, under such circumstances, it would be to suspect the +continuance of that influence with the continuance of effects +identically the same as it or they had already produced, than to call in +a principle whose only evidence of existence was the presence of +effects, the same as had been only a short time before produced by a +different agency, and of whose removal or absence there was not a +particle of proof. + +But a little inquiry will, on most occasions, elicit the fact, that some +pestiferous influences exist; and it will, in general, be soon enough to +pronounce on the probable causes of a distemper after that investigation +has been made. + +Disease in general, unconnected with alterations in the texture of the +organs, is neither more nor less than a derangement of the functions +performed by the body; and as it partakes of a general or local +character, so the disease is either local or general; and, as it relates +to functions, more or less important, so it is more or less dangerous. + +It must be obvious, that a machine so nicely balanced, so complicated +and so exquisitely wrought as the human body, must be liable, on many +occasions, to have its operations impeded and deranged; and, although +sometimes said to be a little world of itself, still, it is dependent on +surrounding agencies. It requires a pure atmosphere for respiration, +food to supply the waste it continually suffers, and drink to appease +thirst, and to take the place of the fluids that are constantly draining +from it. + +The human body is necessarily brought in contact with the external +world; and many are the injuries it suffers therefrom, both directly and +remotely. + +The derangements of the functions of the body are in general owing to +circumstances of an unwholesome character, for the most part relating to +food, drink, the various steps in nutrition, the atmosphere, its +temperature, dryness, moistness, purity, &c. &c., and chemical and +mechanical agents, to whose action the body is exposed. + +Were it not for the operation of unfavourable circumstances of the +nature specified, a body in health, were no special interposition of the +Almighty hand made, would go on in the healthy performance of its +functions, till the frailty and decay, incident to old age, would +overtake it. + +In general those diseases which are observed to prevail to a great +extent, and over a large tract of country at the same time, are so +uniformly coincident with circumstances of an unwholesome tendency, +connected with those agencies above referred to, that they appear at +once to the candid and unprejudiced inquirer, to stand in the relation +of cause and effect. Surely it should cause no difficulty, nor occasion +any necessity for the calling in a principle, atmospheric contagion, +without any other evidence, that those effects are occasionally found +not confined to one spot merely, but are seen developed in an extended +sphere—for, assuredly, it can require no extraordinary effort of the +mind to conceive that the agent acting and causing disease in one place, +or individual case, may with equal force, and with a like result, act in +many situations, and in respect to many persons. + +The presence of certain operations in several situations by no means +proves that they have reproduced themselves. + +Day-light is manifest in many countries, within certain latitudes at the +same hour, but it has never been suggested that this circumstance in one +of them has been propagated by that of another, through any occult +principle, or whatever else such an agency may be called. + +Had the case not presented at once, and in so direct and striking a +manner, a sufficient cause for the effects observed, then we doubt not, +that, perhaps, individuals would relieve themselves of any present +difficulty, and attribute what they could not readily explain, to the +operation of a principle having as little evidence of its entity as +atmospheric contagion itself. But the sun is too glorious, too +resplendent an object to be overlooked, and its effects are too +immediate, to permit the possibility of the most unreflecting, not +marking its relation as cause to the effect observed. + +But, unfortunately, the relation between widely spread diseases or +epidemics, as they are called, and circumstances connected with the +agencies before referred to, is not so striking—though it is as close. +There is no object so bright to draw the same attention to it, and to +proclaim it from east to west, from the dawn of morning till the fall of +evening, like that luminary dispersing light as he appears to traverse +the heavens. + +Yet there is room to believe that the presence of epidemics is always +accompanied, or shortly preceded, by circumstances, which, though by +reason of their less striking character, and less immediate operation, +are sometimes overlooked or neglected, yet do exist, and, were inquiry +made by those able for the purpose, doubtless would be found. + +In most of the epidemics recorded, some such agencies or circumstances +were in operation. They were known to be so—and in almost all that have +come under our own observation, and they have neither been few nor +carelessly noted—there have, on nearly every occasion, been found the +influences to which we allude. + +We are led to believe an agent to be the cause of an effect when the one +follows upon the operation or presence of the other, uniformly, and on +every occasion, when the latter bears some relation in its amount to the +force and length of duration of the former—and when the effect ceases +with the removal of the agent. Such a close connection, as subsists in +that case, entitles the former or agent to be held as the cause of the +effect observed. + +For those very reasons day-light is said to be the effect of the sun +that comes with it, remains with it, and goes with it. + +Let us see if the same connection holds with disease and those agencies +and circumstances we have cursorily referred to. + +Those agencies and circumstances, relating to food, drink, air, heat, +contagious matter, &c. &c. are known to present themselves, and with +them are presented diseases. They are known to remain, and with them are +known to continue diseases. They are known to disappear, and with them +all the world knows diseases disappear also. + +These being the causes of epidemic or widely spread disease, as such a +connection proves, it is altogether superfluous to admit the operation +of atmospheric contagion, whose existence has never been known, but by +the very circumstances which it is said to bring about. + +It is surely most unwise, when we see disease arising with the existence +of unwholesome circumstances, such as scarcity of food, unwholesome +quality of it, great vicissitudes of weather, uncommon conditions of the +atmosphere, want of sufficient clothing or incommensurate with the +severities of the season, the operation of depressing passions, and the +like,—growing with their intensity—extending where they extend—abating +where they decrease—and finally disappearing when they disappear—to +refuse to grant the relation as cause and effect, and to plunge into the +tide of difficulties such ill-timed incredulity creates, with nothing +but the appearance, nothing but the assurance, of an object to grasp at. + +In general, such a connection can be made out between the existence of +wide-spread disease and such circumstances. + +If, in respect to some diseases, so intimate a connection cannot be +observed, the probability is, that it is the obscurity connected with +these subjects, the less direct way in which they operate and the remote +time at which their effects may be experienced on the body, that are the +occasion of the difficulty. The human body, unlike mere inanimate +matter, has the power of withstanding, at least for a time, the +operation of unwholesome influences, if not very virulent; and it is +only natural to allow, that, in respect to a machine so complicated, +affected by so many agencies, and standing in so many relations, there +will be less complete directness of operation, than with simple or +inanimate substances, and more variety in the amount and duration of the +effect. + +On these accounts, the indications of the case are less direct and +obvious, and it should cause no great surprise, that being considered, +and the fact of the imperfect state of our knowledge on the varieties of +the agencies referred to, being kept in mind, that the causes of disease +cannot at all times be completely and satisfactorily ascertained. + +Our knowledge of the derangements of health, from the operation of these +agencies, on some of which we are dependent, and with others of which we +are constantly brought in contact, is fast increasing, and the relation +between the former and the varieties in the latter is becoming clear and +precise. There is, therefore, reason to hope that difficulties which now +baffle us, will soon be explained away, and that much of that mist that +has long overhung the causes of pestilence, will soon be dissipated. + +Certain circumstances produce certain uniform effects, and in every +instance where they are operating, their effects will be produced, +provided no agency is acting adequate to neutralize them. Not one hill +only, in northern latitudes, has its summit whitened with snow, nor does +sterility mark a few spots only in the immense deserts of Africa and +Asia. + +The same features are spread far and wide. They owe their existence to +agencies acting in immense spheres corresponding with their own. + +The sphere of those circumstances connected with the agents so often +referred to, that produce disease, is sometimes large, and no +astonishment need be felt, if that of disease is also large, since a +relation ever holds between the extent of a cause and its effects. + +It would certainly be ample time to call in the assistance of +atmospheric contagion to account for the propagation of disease, when +its sphere or circle is found to be positively eccentric of that of +those circumstances alluded to. + +But we are satisfied that such a contingency is of very rare occurrence, +and even when it is said to exist, we shall require some undoubted +assurance that the non-correspondence is not the result of ignorance of +the extent of these hurtful circumstances, rather than the actual +absence of relation between them. + +It is not our intention at present to enlarge on the causes of disease, +yet we maintain, that such a relation as that referred to, will in +almost every instance be made out, if candid and efficient inquiry be +instituted; so that, even granting that atmospheric contagion exists, +there can be no room for its operation. And we are of opinion, that if, +in some extraordinary instance, no such relation can be detected, the +progress which every department of science is making will in time +achieve what may not be accomplished at present. + +The history of nations and the records of medicine shew, that, +coincident with epidemic sickness, there have, for the most part, been +noticed certain circumstances operating which were prejudicial to the +welfare of the human body. For example, famine, bad or unwholesome food, +great and long continued droughts, great rains followed by intense heat, +sudden vicissitudes of weather, dissipation, irregularities, depressed +state of mind, insufficient clothing and fuel, and unwholesome water. + +These, and many similar circumstances known to prevail in the haunts of +pestilence, must exert a great, a very powerful, influence on the human +body, and, when the question of the probable causes of its diseases is +mooted, it argues a strange and discreditable blindness to obvious +facts, to overlook the part which they must exert in their production; +and a strong and dangerous partiality to a questionable principle, to +attribute the whole calamity to atmospheric contagion. + + + + + CHAPTER II. +THE EVIDENCE DRAWN FROM DISEASE ATTACKING THE RELATIVES, ATTENDANTS, AND + VISITORS OF THE SICK, IN FAVOUR OF ATMOSPHERIC CONTAGION, + CONSIDERED—FACTS EXPLAINED. + + +Few points have been held so conclusive of the existence of atmospheric +contagion, as the circumstance of the attendants and visitors of the +sick being attacked with the same distemper, during, or shortly after, +their communication. + +It is vain to deny, that where a person is ill of a disease, such as +fever, that those about him, the members of his family, his attendants, +and his visitors, are sometimes attacked with the same distemper. + +Such is a common occurrence, but common as it is, it cannot prove that +the efficient cause is atmospheric contagion. + +Were it established that atmospheric contagion existed in that +individual disease, and in that individual case, then it might be +admitted that the circumstance did lend some countenance to the +supposition, and should perhaps entitle the case to examination. + +But it has never been shown that that principle positively exists. There +is, as has already been observed, no proof, saving that drawn from the +very circumstances for which it is called in to account. + +Thus it is entitled to no exclusive respect. + +Here is then an agency, of whose existence there is no evidence of a +sufficient nature, and here there is reason to believe that the same +circumstances are operating widely, and upon the relatives, the +attendants, and visitors of the sick, which have already produced the +disease in those visited. + +These circumstances, in general, are ascertained to be acting upon these +individuals, and where they cannot, from their obscure nature, be +recognised, there is reason, from the very circumstance of the sick +having been affected, to conclude that they are operating, though +perhaps in an insidious way. Now, a question arises, whether it is +wisest to attribute the prevalence of disease among those holding +communication with the sick, to the operation of atmospheric contagion, +or to those circumstances and agencies which caused the disease +originally, and which there is room to believe are exerting their +influence over them also. + +It has been said in the preceding chapter, that, during the prevalence +of widely spread or epidemic disease, there are generally found +circumstances of an unwholesome tendency, favouring its career, and that +the range of their action corresponds with that of pestilence. That +being the case, as it undoubtedly is, it would be proper, before +admitting the operation of atmospheric contagion, to shew that no such +circumstances were in operation. An inquiry would be necessary; and +their presence being proven, it would not be short of imbecility to +attribute to that agency, effects such as are wont to follow their +action. It would be to call in a principle whose existence has never +been proven, and which, therefore, must be held as at least doubtful, to +account for phenomena, the ordinary results of circumstances present, +which would indeed be absurd. + +Before the operation of atmospheric contagion could with propriety be +entertained, it behoved to shew that those circumstances which induced +disease in the visited, were not operating with those holding +communication with them. + +But in all those cases in which atmospheric contagion is held as acting, +no attempt is made to prove such absence, and the belief in its presence +is not the less strong because these circumstances can be proved to be +present. + +It is a self-evident truth that some agency or agencies, totally +independent of atmospheric contagion must have been in operation, and +acting as the cause of disease in the first case or cases that occurred. +For this ample reason, that, for atmospheric contagion to exist at all, +it is obviously necessary that disease pre-existed, since it is the +product of disease, and of disease only. + +Thus, then, it is proved, that some causes, totally independent of +atmospheric contagion, produce the first cases of an epidemic, or widely +spread disease. Now, there is no evidence that these same causes are not +operating upon those who visit the sick, and in absence of any facts to +the contrary, and of the operation of an equally active and undoubted +agent, there is justice in thinking it probable that they are acting, +more especially if the self-same results are manifested—and this may, +with safety, be done, even when direct testimony cannot be +obtained—which is very seldom entirely the case. + +The causes of the disease being widely extended, and the visited patient +being ill from the operation of forces shared in common with many, it is +only fair to conclude that as relatives, attendants, and visitors are +like the great mass of people thus operated upon—that they, _cæteris +paribus_, are as likely to be affected with the prevalent disease, as +those who are suffering were previous to its invasion. + +They do suffer, but not in general in a greater proportion than other +persons having no communication, and similarly situated in other +respects. + +It would be ample time to look for the operation of some other agency in +addition to those commonly experienced, when the portion of the +community, holding communication with the sick, is affected with disease +in a greater proportion than that portion having none. + +Now, with a few exceptions, it is the result of much patient +investigation, not only into the experience of others, but of many +epidemics we have had the most ample means of noting, that, in general, +in respect to diseases held to be propagated by atmospheric contagion, +those who have communication with the sick, do not suffer in a greater +proportion than those who keep apart, but remain in the sphere in which +the agencies and circumstances are operating, which produced the first +cases. + +These exceptions are— + + _1st_, The relations and inmates of the same house inhabited by one + sick of fever. + + _2d_, Those receiving disease from actual contact with the palpable + contagious matter, or by contactual contagion. + + _3d_, Those persons, through the operation of fear, and from + depression of mind, affected with disease, as fever, + cholera, &c. + + _4th_, The attendants in fever institutions, &c. + +These exceptions will meet with a little consideration, in order to shew +in what manner, and wherefore, those persons are seized in greater +proportion, and to prove that it is not in consequence of atmospheric +contagion. + +This statement is important, and is made cautiously, and only after the +most detailed examination, and unprejudiced weighing of evidence. + +The facts which have led to that conclusion might be detailed, but, as +they would occupy much room, and perhaps prove uninteresting to the +general reader, they will be withheld, however, to be produced, if any +sufficient objections be made. + +That statement is contrary to common belief, which attributes disease in +a much greater proportion to those communicating with the sick, than to +those keeping apart; but that is not of much consequence, since implicit +reliance is not to be placed upon the opinions on that subject, held +either by the public or the medical profession. + +On the whole, disease does affect, in a greater ratio, those who +communicate with the sick, than those who do not, the instances which we +excepted being included. But the difference, on the whole, is very +trifling, at least much less than is usually supposed. + +One of the reasons that the difference is thought to be much more than +is actually the case, is, that every case of a visitor or attendant +being affected with disease, after or during communication, is bruited +about, and becomes the subject of much gossip; while that of hundreds, +equally exposed, who escape, is treated very judiciously with silence. +There is no impartial hearing of evidence. All that is heard is taken in +favour of one side, and instead of an opinion being formed from the +whole bearings of the case, one is got up on partial statements, which, +however, as it agrees with preconceived notions, answers very well. + +But that is not the way in which a case so important should be treated. +Be it hoped that medical men, at least, will take more enlarged views, +when their own reputation and the public weal are at stake. + +The partial statements remind us strongly of the self-deception of which +many persons are the dupes, in respect to fortune-telling and the +solving of dreams. Every instance of the divination of the +fortune-teller, or the solution of a dream, having any, the most +far-fetched, correspondence with the future history of the individual, +is stored up in the memory, and adduced as undeniable evidence of the +truth of those dark arts, however much a thousand facts may cry out +against them as vile impositions. The prognostications must, of +necessity, be right sometimes, in much the same manner as Louis the 14th +declared those astrologers must at some time be correct, who were +constantly foretelling his death. + +We now proceed to inquire into the circumstances which cause disease to +attack those having communication with the sick, in a greater proportion +than is observed to hold with those apart from them, yet living in the +sphere of the epidemic causes, that is, generally speaking, in the same +locality. + + +_Exception 1st_, The greater proportion in which relatives and others +inhabiting the same house with one sick of disease, are attacked, we +would explain in this manner:— + +_1st_, The relatives, if inhabiting the same locality, are, like others, +liable to the disease. + +They are suffering in general under depression from apprehension of +losing a dear friend. + +They are, perhaps, under an apprehension that they themselves may be +affected with the same distemper. They may have a dread of atmospheric +contagion, or, as is often the case, may have a presentiment of fatal +sickness. + +They are irregular in the time of taking diet—have often no appetite—are +deprived of their night’s rest—maintain long and anxious watchings—and +are in general in that feverish state of mind that precludes the +possibility of taking due rest. + +They are deprived of their wonted exercise in the open air, and of that +elasticity of mind and body which it imparts. + +They respire an atmosphere, though not contagious, often, and especially +in the houses of the poor, deprived of its oxygen or more important +principle, and tainted with the admixture of adventitious vapours or +gases arising from the excretions, and perhaps the fermenting of +impurities often found collected on the skin. + +It would be wonderful, where there is a widely-spread disposition to +disease, say to fever, if members of the same family, inhabiting the +same house, in which one of them lay ill of that distemper, did not take +ill, seeing how much they are exposed to it. + +Nor is it to be thought extraordinary that relatives living in the same +locality, but in different houses, or even in different villages, should +take the disease also after visiting the house of a sick friend. What +has been stated will sufficiently explain that occurrence. + +Here it will perhaps be permitted to make a slight digression to mention +a fact which has given much credit to the doctrine of atmospheric +contagion,—the simultaneous invasion of fever among relatives, living +together, in different houses, in different villages, and in very +different parts of the country. We are aware of several extraordinary +instances, where from ten to twenty of the same family were ill, at the +same time, of fever, several of whom were living far apart. + +It is in vain to think of atmospheric contagion being the cause. +Possibly that notion might be entertained in reference to those living +together, and having communication,—but cannot possibly apply to those +in remote and different parts of the country. We know of instances where +a family has been seized with fever in our village, and members of the +same, living at great distances, forty and sixty miles, have suffered +the same distemper at or nearly at the same time, without any +communication having subsisted, either by person, by packets, or by +letter. + +These extraordinary circumstances speak of something more than +atmospheric contagion. That could not possibly have extended to those +relatives who had no communication; and it is remarkable that, in those +instances, disease did not go as with the other members of the +community, attacking at leisure, now this, now that one, but almost on +the same day, many different members of the same family. + +We have sometimes thought, from the consideration of such circumstances, +that there is something like a community of disposition causing members +of the same family to be similarly affected by like agents, more than +subsists between men who are unconnected:—something like an +idiosyncrasy, which goes to make them suffer after the same fashion. + +There are such things as family characters, family idiosyncracies, +family dispositions, family peculiarities of bodily conformation, and +family temperaments; and may there not exist some family disposition, to +be similarly affected by like circumstances? + +The case appears well worthy of philosophical inquiry, something beyond +the untenable puerilities of Mesmerians. + + +_2d Exception._—Visitors and attendants are liable to increase their +ordinary chance of taking the prevalent distemper, by touching the body +or clothes of the sick, when he labours under a disease marked by a +palpable contagious poison. Though the poison cannot be diffused through +the air, it may, and sometimes does, act by contact, which we call +contactual or immediate contagion. That, of course, can operate in those +diseases only in which a palpable poison is eliminated. Those diseases +are in this country chiefly small-pox, chicken-pox; the plague, if it +can now be said to be a disease of this country; the itch; and, as is +commonly believed, measles, scarlet fever, &c. &c. + +Though the propagation of these diseases may take place from contact +with their peculiar contagious matters, we are disposed to think, that, +at least with most of them, especially the latter, the cases which occur +in that way are very few. + +It is sometimes difficult to produce disease, even when the skin is cut, +and the matter is then introduced. That step sometimes fails in respect +to cow-pox matter, even when fresh; and small-pox matter we have known +to be in contact with the tips of the finger for a minute or so, in +innumerable cases, as in feeling the pulse, and no disease has followed. +Women affected with small-pox bear healthy children. + +Almost the only diseases which we are disposed to think are propagated +by contact with the person or clothes of the sick, are small-pox, +chicken-pox, scabies, plague, &c. They all possess palpable matters in +abundance. + +Many instances are known to us, where children have got small-pox, and +of grown-up people who have got itch, from sleeping with those sick of +these distempers, and thus coming in contact with them closely, and for +some time; and where they have not been seized with them, when only +breathing the same atmosphere used by those sick. + +Thus visitors and attendants may get disease by contact with palpable +contagious matter, that is, by contactual contagion, and by touching +clothes impregnated with the same, that is, by fomitic contagion, which +they would not have taken, had they merely been respiring the air used +by the patients. + + +_3d Exception._—The visitors, and those in general holding communication +with the sick, are also liable to be affected more with disease than +others who remain free of it, on account of the sorrow usually felt on +all occasions of public calamities, and particularly of very mortal +pestilence, and more especially experienced in all its acuteness, in the +silent sick-room of a friend. + +Among the scenes our professional duties call us to witness, there is, +perhaps, none so touching as the sorrow-striken countenances of friends, +directed to the sick, nay, perhaps the deathbed of one they love; and we +have noted the unspeakable sorrow then felt, the deep anguish then +experienced, and the silence more touching than eloquence that reigns +throughout the sick-room, as an awful contemplation, truly indicative of +a depression that is calculated to throw its sufferers into the same +situation which they so much deplore in others. + +That sorrow attendant on such calamities, and that was so well marked, +when cholera lately assailed the nations of the earth, throws into the +shade almost every other form, sinks deep into the soul, and enervates +every principle of life. It gives a pall to every taste, a disregard to +all enjoyment, deprives the unhappy victim of that serenity and +composure so favourable to health, and, on the contrary, imparts a +restlessness to body and mind, until at length his system becomes a very +nidus of disease. + +None who have attentively watched the course of widely-spread disease, +can doubt that that sorrow, so generally experienced on those occasions, +is an active instrument, and a strong abettor of the original epidemic +influences. It must be obvious to them, that those strong and +deeply-felt emotions, with which man contemplates his relatives, his +neighbours, aye, his very race, falling around him,—feeling, too, that +he is in the midst of danger, and can do nothing for his security,—must +produce a withering influence on the most vital functions of the body, +and prove the immediate cause of disease. + +Under such circumstances, when disease manifests itself, it certainly +cannot be wise to disregard the part they must enact in the production +of the effect observed, and to attribute the whole, or nearly the whole, +to the operation of atmospheric contagion, which has already been shewn +to be without sufficient evidence of its existence, in any one case, or +in any one disease. + +The visitors, also, are exposed to the action of an atmosphere, which, +as it is sometimes impure, is liable to be hurtful. + + +_4th Exception._—That of the attendants in Fever Institutions. It has +often been remarked, that in some fever institutions the nurses and +medical clerks resident in the house, are attacked with fever in a much +greater ratio than holds with the population around. The difference has +been seen on some occasions to be very great, and from information +collected on the subject, we are disposed to think, on some occasions, +and in reference to some institutions at least, that the statement is +correct. That fact has been attributed to atmospheric contagion; and we +shall proceed to inquire if it is not more likely that it is dependent +on other circumstances which are operating, and that are known to be +adequate for the effect observed. + +The history of the Royal Infirmary of Edinburgh, and of Queensberry +House, an institution for the reception of fever patients, shews that on +some occasions almost all the clerks and nurses waiting upon those +affected with fever, have been seized with it also. + +And it would appear to be owing to some agency peculiar to fever +patients or their wards; for in regard to the first-mentioned +institution, it is ascertained that it is with those attendants only, +who wait upon those patients, that the greater amount of sickness is +experienced. Those attendants exclusively occupied in the surgical wards +being attacked in no greater proportion than those unconnected with the +institution. + +This is certainly an important fact, and one on which the advocates of +atmospheric contagion are wont to place no small weight. Did that +principle exist, there is perhaps no fact in the whole history of +medicine, on which we would place more reliance in proving its +operation, for it is self-evident that nothing relating to the general +unwholesomeness of the institution can be entitled to much activity in +this case, for any insalubrious tendency of its situation, of the soil +on which it stands, or emanations therefrom, and of the general economy +and discipline, cannot be confined in their operation to one apartment +or ward, cannot possibly be experienced in the fever wards only. + +But an occurrence of this kind is apt to be too readily received and +made the ground of many inferences. In itself it certainly is a strong, +a cogent fact, and such as naturally leads the mind to believe, that, as +some very potent agency is at work, it may be that of atmospheric +contagion, which in alleged activity is surpassed by none. + +Before proceeding to explain the occurrence, on principles very +different from atmospheric contagion, it is right to say that it is such +as does not occur in connection with all such institutions; and that, if +the case which has been stated, proves it is likely such a principle as +contagion is present in these institutions, that others of a directly +opposite nature, and as much to the purpose, can be produced to shew, +granting the possibility, that it is not present in other institutions, +much larger. + +By physicians of the first eminence, such occurrences as that referred +to in connection with the Royal Infirmary of Edinburgh, are held as +decisive proof of the operation of contagious atmosphere. + +Dr Alexander Tweedie, a physician of London, and one justly eminent, +after mentioning the self-same cause, goes on to say, in a sufficiently +assured tone,—“No statement more conclusive, as to the contagious nature +of fever, need be adduced: and if such facts will not lead to +conviction, the mind of such a sceptic must be strangely constructed +indeed.” + +The case had been made much stronger, and would have stood inquiry much +better, had Dr Tweedie shewn, that the occurrence he treats of was not +solitary or uncommon, but was such as is wont to be observed in all like +institutions. + +He should have known, that it is not from extraordinary, nor even from +unique cases alone, that knowledge is to be obtained, nor laws deduced, +of the ordinary characters, and action of disease. It is dangerous to +deduce inferences, and construct laws, from the knowledge of one +circumstance, and where, too, many can be obtained bearing on the case. + +Let us see if this occurrence holds with other establishments. We will +find that it by no means always holds. + +Dr Bateman, who saw much of fever, and gave it much of his active +consideration, in his excellent Treatise on Contagious Fever, +says,—“During the fourteen years, in the course of which I have almost +daily been in contact with persons labouring under contagious fever, not +only myself, but all the nurses have been preserved from infection, with +one exception, down to the period of the present epidemic” (in the +London House of Recovery).[3] + +Footnote 3: + + Bateman on Contagious Fever, p. 154. 1818. + +Similar cases of exemption might be given, but it seems unnecessary to +say more here. + +But though Dr Bateman’s evidence in a manner meets the case recorded, +connected with the Royal Infirmary of Edinburgh, yet it does not +disprove its correctness; and we proceed to explain what has been held +as only to be explained by the presence of atmospheric contagion. + +But though the case could not at present be explained, we deny that one +such circumstantial piece of evidence should outweigh the many facts, +and the results of reasoning, that have been laid before the reader, and +that are yet to follow. + +When evidence is contradictory, it is well to ascertain on which side it +preponderates; and even when it is nicely balanced, which is not the +case here, it should be tested by a reference to general principles. +That was done in the first part of this work, and the reader cannot have +forgotten the result. + +We are disposed to think, that the great prevalence of fever among the +nurses and resident medical attendants of fever institutions, and fever +wards in general hospitals, which does occasionally occur, is, in no +small degree, owing to the particularly great contamination of the +atmosphere, which is liable to take place from the peculiarly strong +tendency there is in the body of those labouring under fever, especially +of the low or typhoid character, to run to putrescence. + +The body, it is ascertained, so afflicted, is particularly prone to +putrefaction, as is sufficiently attested by the presence of black spots +upon the surface, sordes upon the teeth and gums, and the general +appearance of corruption, often sufficiently manifest. + +The secretions and excretions are marked at first by a putrid character, +and in a short time they are in an active state of putrefaction. In that +state, chemical changes take place, gases are evolved, such as nitrogen, +hydrogen, carbureted hydrogen, phosphureted hydrogen, singly and +combined, forming for instance ammonia, which is a combination of +hydrogen and nitrogen: they become mingled with the atmosphere, and +impart to it pestiferous qualities. + +In fever, the body is much more prone to run into the state of +putrefaction, than when in health, or even when affected with merely +local disease. The whole system is then affected, the whole functions +are deranged, the decayed parts of the blood and solids are not removed, +nor are they corrected by admixture with new and purer elements obtained +from the products of digestion. The correcting influence of exercise is +lost, and likewise the assistance it gives to the due performance of the +various secretions; and it need not cause surprise that a body so +situated, for days and weeks, becomes at length prone to putrefaction. + +It will perhaps be argued, that the same corruption or contamination of +the air is as likely to take place in the surgical wards, where patients +are kept having sores, &c. But in those wards, in general, there is not +the same amount of tendency to putrefaction. Their health is often +excellent, their functions are often not at all deranged, and their +bodies, in general, are not more prone to putrefaction than those in +health. + +There are, to be sure, a multitude of sores and the like, but, as long +as they are healthy, and the matter is good, there is no risk of their +injuring the air, provided they are kept tolerably clean. + +Healthy matter is a bland and innocent fluid, not more prone to +putrefaction than healthy blood. When healthy, matter may be present in +an apartment or ward in abundance, without the least injury being felt +by those respiring the atmosphere in the room in which it is contained, +as the history of surgical hospitals amply proves. + +But as soon as matter, by any means, becomes of a bad character, acrid, +fretting, unkind, and prone to putrefaction, then it sends forth gases, +and perhaps, compound agents, produced by their combination, which +mingle with the atmosphere, impart to it most virulent properties, and +thus produce havoc among the various patients, as great, as well marked, +and as dreadful as those sometimes observed among the attendants of +fever patients, from the supposed operation of what has been considered +atmospheric contagion. + +Wounds are much connected with the state of the general health. Where +that, by any means, is affected in a serious manner, the wound takes on +an unhealthy aspect, and the matter, which before was bland, becomes +acrid and irritating. If the body is affected with a putrid taint, then +the matter takes on the same, and from the emanations spoken of, disease +spreads around the ward. + +That dreadful disease, called hospital gangrene, was some years ago a +common affection in military hospitals, from effluvia, and inattention +to ventilation; and it was common to observe healthy wounds taking on a +sphacelating character, from such causes. Sir John Pringle says, “I have +seen instances of it (hospital fever), beginning in a ward, where there +was no other cause, but one of the men having a mortified leg.”[4] + +Footnote 4: + + Sir John Pringle on Diseases of the Army, p. 288. + +There are other circumstances of a hurtful character, operating in +general upon the young gentlemen who fill the offices of clerks, and +upon the nurses, in these establishments, which we doubt not co-operate +with the other circumstances mentioned, in producing the extraordinary +amount of disease sometimes observed among them. But of these which will +readily suggest themselves to all, it is unnecessary to say much in this +place. + +It is in the fever wards principally that contagious atmosphere is +apprehended. + +The young gentlemen officiating as clerks are generally arrived at the +most important part of their course of study. They are in preparation +for their examination before the colleges, and are often in consequence +in a very feeble state of health—which, if not always marked with actual +sickness, is often sufficiently indicated by worn out and emaciated +systems, and by complexions of a very sallow or sickly colour. They are +thus predisposed to fever. The nurses waiting upon fever patients are +subject to more fatigue and more interruptions to their rest, on account +of the great attention which those under their care require, than the +same class of persons are exposed to, who belong to the surgical wards. + + + + + CHAPTER III. + THE ARGUMENT DRAWN IN FAVOUR OF THE PROPAGATION OF DISEASE BY + ATMOSPHERIC CONTAGION, FROM DISEASE APPEARING IN PREVIOUSLY HEALTHY + HOUSES AND LOCALITIES TO WHICH PERSONS SICK, OR LATELY SO, HAVE BEEN + REMOVED. + + +A case of an apparently strong nature is made out in favour of the +propagation of disease by atmospheric contagion, when a person labouring +under sickness or lately recovered from it, is removed into a house or +locality in which the same malady shortly manifests itself. It is often +held conclusive; we hold it otherwise. + +Such a case is known to take place, and we have observed it in our own +practice—but that is not entitled to be considered conclusive. It should +be shewn, if that inference is at all to be arrived at, that the +occurrence is so frequent that the probability is precluded of +attributing the phenomena observed to the ordinary causes of disease, +that the number who thus suffer is greatly more in proportion than holds +among the population generally, and that, in short, those thus visited +by the sick are affected in a greater ratio than holds with the general +community, as ascertained by an observation of the whole course of the +disease or epidemic. + +We know that the appearance of disease among those visited by the +sick, or those lately recovered, does not always happen. We ourselves, +scarcely recovered of typhus fever, have visited and lived with a +family at a distance, and no such thing as propagation has +occurred—and hundreds of other cases are within our knowledge. We +have, after making calculations on the subject, considering both those +cases, where disease did occur and where it did not, that, generally +speaking, those visited by convalescents, or even patients, suffer in +a proportion very little greater, if at all greater, than those having +no such intercourse—compared of course with the very many cases that +are wont to occur in a widely spread epidemic. + +Yet, though the general proportion may not be much affected, still we +are ready to admit that a case does now and then occur, where disease is +shortly observed after the admittance of a sick person in a house or +locality, and where the effect is so marked, so immediate and so general +among those exposed, that we are compelled to admit that there is room +for thinking, that the patient is somehow or other, in some degree at +least, the occasion of the catastrophe. + +It is sometimes observed that servant girls, affected with typhus fever, +are in that state sent to their homes, and that disease shortly affects +their brothers and sisters, but before such cases can be held as proving +the existence of atmospheric contagion, there should be a strong +assurance that the agencies of a most unwholesome character, known to +exist in such cases, are inert, and that they which have on other +occasions, without assistance, produced of themselves the distemper +observed, have been altogether impotent and inactive. + +Their case produces the usual effect, demands the exertion of night +watching, spoken of already, as favourable to the accession of disease, +and their house or apartment, close and confined as it usually is in +that rank of life, becomes the abode of many unwholesome influences, and +among others, of an atmosphere, deprived in a great degree of its more +essential part, and loaded, too, with foreign gases, and even perhaps +with chemical compounds of a virulent character, the products of +putrefaction. If disease spreads much among those thus exposed, it seems +fair to attribute the occurrence to these agencies known to be present, +and known to be favourable to the production of sickness, and not to +atmospheric contagion, as is almost universally done. + +The case of disease appearing in a house previously healthy, after +receiving one just recovered of disease, which it is by the way +consonant with our experience to say, is much more rare than the other, +or that of persons actually ill,—is occasionally noticed, and the +explanation, perhaps, is, that the clothes may retain impurities +acquired during the course of disease, and may on this occasion shew +their activity. + + + + + CHAPTER IV. + THERE IS NO EVIDENCE THAT ATMOSPHERIC CONTAGION TRAVELS, OR IS + COMMUNICATED FROM ONE PLACE TO ANOTHER. + + +The question of the communication of atmospheric contagion from one +place to another has almost universally, on occasions of pestilence, +been much agitated, in respect to individual diseases, but seldom in a +comprehensive way, embracing all diseases. We propose to inquire +generally into the facts which are held to prove the principle of +dissemination from one place to another—whether contagious atmosphere is +transmitted from one country to another, from one town to another, and +from hamlet to hamlet. + +In the many works written by medical men on occasions of great epidemic +disease, descriptive of the character of the prevalent distemper, there +almost universally appear the most minute accounts of the route pursued +by contagion, both fomitic and atmospheric, down to the noting of the +very road, the very street or alley by which it reached a town—and of +the manner in which it arrived, whether on the rags of a tattered +beggar, or seated in a stage-coach. + +The line of its progression is taken from the observation of disease, +and from that alone. Wherever disease appears, there it is said that +contagion has been carried or conveyed; and as a proof of that position, +it is gravely maintained, that disease invariably breaks out where there +are houses, and where communication is likely to be going on in some way +or other. This most extraordinary fact proves what must certainly be +thought not less extraordinary, that it appears in the abodes and +habitations of men. But where else is disease, we would ask, to manifest +itself, if among men at all, if not where alone they are to be +found?—surely not among deserts uninhabitable, or on the frosty summit +of an iceberg? + +It is true that in the course of an epidemic, such as the cholera, one +country suffers before another; but there is no alternative to such a +course if they are not to be simultaneously affected. And it signifies +nothing that communication subsists between them. One part of a country, +too, is ravaged first, then another, and so on—one town then another—one +part of a town, and after it another part. + +But it is evident, that if disease is to begin at all, it must begin +somewhere, and if all parts are not to be seized on the same instant, +that one will have precedence of another, and so on. Springing and +propagating, from whatever causes, that character must hold, and surely +it is wrong to hold a feature common to the effects of many causes as +decisive evidence of the operation of one, and of one only. + +The harvests of Europe begin in one country, sooner than in another. In +many, harvest is earlier than in England, but it is never surmised that +when that process begins in the latter country, that it is through the +mediation of some such influence as contagion. It begins in England, +too, it might be shewn, in places having communication with foreign +countries. Nay, it might also be proven that the parts in which it in +general commences are at the coast, where it is well known ships are +wont to appear. + +Were such an insane supposition made, the most obvious facts would +necessarily be laid aside; but such gross blindness would not, we are +satisfied, be much greater, than when the process of diseased action, +marked out in an epidemic, is attributed to contagious atmosphere alone. + +In the case of the harvest, it would argue a forgetfulness of the object +held in view when the seed was sown,—in that of disease, an ignorance of +the effects to be expected from the sowing of the seeds of pestilence +(the exposure to the common epidemic influences alluded to above), in +the first, an insensibility to the influence of climate, intensity of +sun’s rays, the quality of the soil, &c.:—And in the other, a blindness +to the operation of circumstances not less potent, such as the time of +application of the causes, the condition of the body, and the presence +or absence of moral adjuvants. + +It has universally held with all epidemic sickness, that parts of a +country have been attacked in succession—that one town is visited after +another, and one part of a town before another, whether the prevailing +distemper have or have not been said to depend on contagion. + +There is nothing extraordinary in the fact that all persons who are to +suffer, do not become affected on one and the same day. Far from proving +that any thing of the nature of contagion has been in operation, it only +proves what may so readily be admitted, or at once readily understood, +that all and sundry the inhabitants of a vast tract of country, +inhabiting parts having different climates more or less mild, having +different situations, some on the banks of rivers, some along the coast, +some inland, some on boggy and some on dry soil; having different +occupations, different houses, wearing different dresses, having +different habits, different pursuits, different diet, different +recreations, and perhaps having constitutions differing in aptitude to +be acted upon, may not be all ready for the manifestation of disease on +one and the same day, but may attain to that point at times +corresponding with the operation of so many different circumstances. + +In vegetation, which on the whole is much more simple than living animal +organization, there is a gradation in the time at which its various +individuals become ripe. The same grain is ripe in some districts weeks +before it is ready in others, and even in the same farm, though the seed +had been sown on the same day. Thus, by observing that the gradual +development of disease over a country is the result of the varying +activity and time of action of the epidemic influences, and perhaps of +some condition of the body, varying in forwardness—it becomes +unnecessary to have recourse to atmospheric contagion. It is unnecessary +to repeat here what has been said relative to the operation of +unwholesome agencies to account for the wide range of disease—over a +country. + +It is often said, as decisive proof of disease spreading by contagion, +that a beggar, or some poor person left a town affected with disease, +and entered another hitherto healthy—and that afterwards disease +manifested itself there also. + +In the first place, would not sickness have occurred notwithstanding? +Its supporters say, not likely, when the effect followed, or immediately +on the communication; but we reply, that communication took place before +without any such immediate result, and that in all probability it had +been going on freely all along, whatever regulation and hinderances +might have been adopted. + +It seems madness to think of stopping all communication with towns, in a +free country such as this, where human intercourse is going on without +interruption throughout the entire empire, or, indeed, anywhere at all, +tolerably inhabited, or where commerce subsists. + +It is in vain to endeavour to shew that opportunities for the +transmission of contagious atmosphere have not occurred. The case +involves an impossibility, for do not a thousand means of communication +suggest themselves to the mind of the reader? The atmosphere itself, +currents, winds, water, streams, &c.,—animals,—such as rats, mice, +winged insects, &c. &c., which cannot be prevented from operating. We, +therefore, leave this case, perhaps to the efforts of the advocates of +quarantine regulations, who possibly may arrive at a happier result, and +we proceed to the opposite case, where disease fails to spread, where +communication does take place. + +The advocates of contagion prove, where a disease appears in a town, +that communication has taken place. That statement, as the reverse, can +never be proven, is easily affirmed; and its insignificance corresponds +with the facility with which it can be proven. Of course, it is obvious, +that such a fact proves very little, either in reference to contagion or +anything else. + +We are prepared to prove, that communication has subsisted on many +different occasions, without any unusual amount of sickness taking +place. We know of many instances where disease has been prevailing in a +town or village, which has failed to manifest itself in another at a +short distance, although daily unrestrained communication was held. + +At the end of the year 1835, and the beginning of the year 1836 the +scarlet fever prevailed in Edinburgh to a great extent; and although +great traffic was constantly going on between that town and Tranent, by +means of foot-passengers, numerous carts and coaches, passing to and +fro, daily, still that distemper failed to make its appearance in the +latter town till the 20th of January, the day on which the first case +was noticed. + +That case did not occur at the point where the greatest thoroughfare +subsists, but at one, the most remote from it. + +Typhus fever has been prevailing, to a great extent, in Edinburgh, for +many weeks past, but that disease has failed to make its appearance in +Tranent (ten miles distant), although the road is constantly crowded +with carriages, with vast numbers of carts conveying coals from that +village to the capital, and with passengers both on horse and foot. It +has not made its appearance, although several of the inhabitants of +Tranent have lately lost relatives who have died of that disease, both +in Edinburgh and Leith; and although a woman just recovered from that +distemper, and come from the Royal Infirmary, has taken up her abode in +this village. + +Small-pox appeared about six weeks ago, simultaneously in two very +filthy localities in Tranent, and it has been confined to them, although +the most free communication has subsisted with other parts of the +village, and it has failed to spread to the hamlets and farm-steadings +around, notwithstanding the relatives of some of those labouring under +that disease have travelled through the country, seeking charity. + +We propose to close this part of the work. Much has been said in order +to prove the position, that the doctrine of atmospheric contagion gains +no support from the actual character of disease, no countenance from the +ungarbled history of its career. + +Arguments in favour of our views might have been drawn from the fact, +that diseases said to be propagated by contagion, do not manifest +themselves in all parts of the globe to which the poison would be likely +to be taken, as they undoubtedly would do, were they dependent on the +operation of one single object, such as contagious matter; and also from +the consideration that those diseases, with whose causes we are +intimately acquainted, by reason of their immediate operation, or of +their being otherwise obvious, such as inflammation and wounds, are +never said to be dependent on such an agency; but it is feared in the +endeavour to be explicit, we have already been tiresome. + + + + + CHAPTER V. + ON VITIATED AIR. + + +The question of air holding in solution, an animal contagious matter, +eliminated in the body of a sick person, and capable of producing the +same disease, when inhaled by another, has hitherto occupied our +attention. + +It is now our design to treat of vitiated air, that is, an atmosphere +deprived of part of its more essential principle, viz. oxygen gas, or +tainted with the admixture of effluvia or gaseous products, from +putrefying animal bodies, both living and dead, and from corrupting +vegetable matter. + +It is one of the most common, and most widely spread causes, of the most +virulent and widely prevalent diseases, to which humanity is subject. + +The importance of the atmosphere to the animal economy, is so very +great, and its derangements so very hurtful to health, that it appears +that a few observations respecting it may be useful to some +non-professional readers. It may enable them to understand better the +observations that are to follow on its vitiation. + +The atmosphere is a fluid of an elastic nature, encompassing the globe, +occupying the space comprehended from its surface, to the distance of +twenty or thirty miles therefrom. It possesses weight, and it is by this +property that water rises in pumps, and that mercury is sustained in the +barometer. It is in constant motion, going, as it does, with the globe +itself, revolving on its axis, and rushing, in counter streams, from the +tropics to the poles, and from the poles to the tropics. + +That portion nearest the sun becomes rarefied and lightened with the +heat which it acquires:—it then rushes, by virtue of its comparative +lightness, to the poles, and that in temperate regions presses forward +to occupy its place. + +By means of this motion, the temperature of the earth is kept pretty +uniform, and it is corrected of any impure taint it may acquire. + +The atmosphere is composed of two gases, oxygen and nitrogen, a small +quantity of watery vapour, and a fraction of carbonic acid gas, or fixed +air. + +Oxygen is the agent on which its more active properties depend. The +other component, viz. nitrogen, serving to dilute it. + +They are united in the proportion of about seventy-seven of nitrogen by +volume, and twenty-one of oxygen, the rest being made up of watery +vapour, and carbonic acid gas. + +The atmosphere supports combustion,—oxygen gas being the essential +agent. During combustion, it is consumed, and at the end of the process, +it will be found wanting,—the other gas being undiminished. + +This may be seen, at least the diminution in the volume of air, by +burning a candle in a large wide mouthed bottle, inverted over coloured +water. As it continues to burn, the water ascends in the bottle, and +occupies the place of the oxygen consumed. + +Atmospheric air supports respiration, a process essential to the +continuance of life. Oxygen gas here, too, is the agent on which it +depends. Air, which has been once respired, is found to be deprived of +part of its oxygen, from ten to twelve per cent. + +Air, deprived of oxygen, or even deprived of a small portion of it, is +unfit for respiration. A mouse, put into a vessel containing air, which +has been robbed of that fluid, dies immediately. Put into one containing +pure air, it breathes well at first, but, as the oxygen gets less, its +breathing becomes laboured, it is convulsed, and shortly dies. + +The air is concerned, besides, in a thousand operations, constantly +going on at the surface of the earth. It gives up a portion of its +component parts in an immense number, and in a considerable proportion +receives bodies foreign to its constitution. + +By one set of operations, it is deprived of its oxygen, and becomes +vitiated by the admixture of deleterious principles. By others, again, +its oxygen is restored, and the impurities removed; so that between two +opposite forces, it is in general kept in a wholesome condition. + +An immense number of bodies on the surface of the earth, are constantly +attracting to themselves the oxygen of the air; some become what is +called oxydized, as the metals, the dull incrustation which is found +upon them after long exposure to the air, being an oxide, or a +combination of the metal, and the oxygen of the air. Some bodies become +acids, as the various vegetable juices which form their respective +acids, by combination with the oxygen of the atmosphere. + +During fermentation, the oxygen is absorbed, and carbonic acid is +evolved. During putrefaction, oxygen is taken up also. There are many +operations, too, connected with the arts, in which that fluid is +abstracted from the air. The very soil is constantly acting on the +atmosphere, and is, indeed, one vast and extended laboratory, where +chemical processes, on a large scale, are going on without interruption. +The putrefaction of the animal and vegetable materials, used as manure, +is much promoted by free exposure to the air; hence one of the +advantages of ploughing the land so universally adopted. The very nature +of the soil is greatly altered by that process, and much of that change +depends not only on the chemical processes just spoken of, but upon the +action of the air itself, on the essential particles of the clod. From +the surface of newly turned up soil, it is understood by intelligent +agriculturists, that much gaseous or elastic vapour is evolved; and we +have heard it observed by intelligent ploughmen, that one of the most +delightful things is the air which arises from newly ploughed fields in +the morning. It is said that it imparts an invigorating, and wholesome +sensation throughout the body, and from thence to the mind. + +All those processes we referred to, abstract from the atmosphere its +most essential part, the oxygen gas. Did that process of abstraction go +on without its being counterbalanced by others, imparting that principle +to supply the place of that abstracted, then the atmosphere in the +course of time would become unfit to support combustion or flame,—unfit +to support animal respiration; and the consequence would be, that the +surface of the earth would soon be uninhabitable, would soon be a +lifeless desert. Such would be the inevitable consequence. + +But a wise and a good Creator has prevented the occurrence of that +catastrophe. He has so ordered it, that one department of nature shall +correct the bad tendencies of the other;—he has placed a weight at the +opposite end of the balance, to counterpoise and balance the glorious +work of his hand. Animal life is met by vegetable life: their results +are made to neutralize those of each other, and with a wisdom truly the +Father’s, found in his works alone, he has made the apparently hurtful +consequence of animal life, the very means for the maintenance of the +life of vegetation. The results of the function of respiration so +necessary to animals, are highly useful to vegetables. Those products +that are hurtful are absorbed by the leaves of plants, which are +analogous to our lungs or breathing apparatus, and the oxygen consumed +by animals is replaced by the evolution of a large quantity of that +principle. + +During sunshine, plants, especially in water, give out a large quantity +of that principle, as may be seen by putting grass leaves into a jar +filled with water, and exposing them to sunshine. Bubbles of air soon +appear, and collect at the top of the jar; they are oxygen gas. + +The evolution of oxygen gas in sunshine, is the chief means with which +we are acquainted, by which the chemical equipoise of the atmosphere is +maintained, against the operations constantly going on, to which we +alluded. + +These observations relate to the chemical composition of the air, +considered as one great whole. + +There are many situations in which it becomes not only deprived of its +oxygen in part, but becomes vitiated by admixture with foreign bodies or +vapours, most detrimental to health, in short, most pestiferous. But, +before pointing out the manner in which it becomes so tainted, and its +unwholesome consequences, we would here point out the use of the +atmosphere. By the act of respiration, air is carried into the lungs; it +acts upon the blood brought there in large quantities, and spread out in +innumerable vessels, forming a sort of network. The blood, upon its +arrival at the lungs, is dark, grumous, and unfit for the maintenance of +life, and the nutrition of the body; but, under the action of the air, +it becomes florid or crimson, has changes wrought upon it, by which it +is fitted to perform its various and important functions. + +This chemical process gives a crimson and florid hue to the old blood of +the system, and imparts a colour and other qualities to the fluid +brought from the bowels, the result of digestion, which give it the +character of blood. It gives to that fluid the last preparation before +being converted into blood. + +The heat of the body, which is above that of the surrounding atmosphere, +is maintained by the chemical changes which occur between the mass of +blood in the lungs, and the air to which it is there exposed. There is a +constant generation of heat, which is diffused along with the blood +throughout the whole system,—to supply the place of that which is ever +being abstracted by surrounding bodies, among which exists a constant +tendency to preserve an equilibrium of temperature. + +When the atmosphere is vitiated, it is reasonable to suppose, that the +changes in the blood passing through the lungs will not take place in +their wonted integrity, and that, among other results, a diminution of +the vital heat of the body may be experienced. + +Vitiated air admits of division into different kinds:— + +_1st_, Into air simply deprived more or less of its oxygen. + +_2d_, Into air holding in solution, or having mingled with it, effluvia +from animal bodies, living and dead. + +_3d_, Into air holding in solution, or having mingled with it, noxious +gases or effluvia arising from decomposing vegetable matter. + +Vitiated air, of every kind, is unwholesome and favourable to the +invasion of disease. + +Vitiated air has been coexistent with many of the most appalling +visitations of disease, which have befallen man since the creation of +the world. It delights in the production of the most formidable +distempers, such as are marked with extreme debility and proneness to +the putrefactive character. + +The plague, in its various visitations, from the time of its prevalence +in Athens, as described by Thucydides and Lucretius, down to the period +when it last raged in England, viz. in the year 1665, has been observed +to be coincident, for the most part, with circumstances proving the +existence of vitiated air: and at this day the most mortal diseases +prevail, where foul air exists, whether that arises from this or that +source. + +The atmosphere becomes vitiated, when great numbers of men in health are +crowded together in apartments too close and confined to admit of a +sufficient supply of pure air for the perfect maintenance of +respiration. In this case, the vitiation is effected by the abstraction +of the oxygen of the atmosphere, the exhalation of carbonic acid gas, +and the dissemination of effluvia which arise from the bodies of those +who are confined. + +The immediate effects of confinement to an atmosphere thus vitiated are, +oppressed breathing, sense of great anxiety and suffering, fixedness of +the eyes, and torpor, which gradually increases to insensibility; and +the miserable sufferer dies bereft of sense and motion, from +suffocation. + +When the atmosphere is not so impure as to cause immediate death, +disease of a putrid character, for the most part takes place. Typhus +fever attacked those persons who survived the memorable struggle in the +black hole of Calcutta. + +A low form of fever used to commit great havoc in jails and other places +of confinement, where prisoners were wont to be crowded together in +great numbers, from the atmosphere being deprived of its more vital +part, and being loaded with unwholesome emanations arising from the +filthy persons, and clothes of those confined. + +This disease is called “Jail Fever,” and manifests a peculiarly +malignant character. + +In hospitals crowded with wounded soldiers, but otherwise in health, +where sufficient ventilation cannot be maintained, the same distemper +makes its appearance, and is there denominated “Hospital Fever.” + +In besieged towns and in camps, where the inmates are exposed to the +offensive and unwholesome effluvia, commonly experienced in such +situations, the same putrid disease prevails, and goes under the name of +“Camp Fever.” + + + AIR VITIATED WITH EFFLUVIA FROM BODIES IN A STATE OF DISEASE. + +Air vitiated with effluvia from bodies in a state of disease, and their +excretions, has been variously denominated. + +By some it has been styled “Contagious Air;” by some “Infectious Air;” +and, when it is in connection with fever, “Febrile Miasm or Contagion.” + +Vitiated air of this kind differs from that referred to above, in this +particular, that it arises from bodies in a state of disease. + +Both forms of vitiated air produce, or assist to produce, disease of the +same character; but as the latter form not only goes to produce disease, +but arises from disease also, it has been considered to be analogous to +the contagious poisons, such as those of small-pox, cow-pox, and the +like. + +From the circumstance of this vitiated air arising from persons in +disease, and assisting in the propagation of the same malady, it has all +along been regarded as a specific contagious animal poison in an +atmospheric menstruum; and thus has been created the perplexing and +entangled web of confusion and vagueness that has been wove around the +principles, viz. contagious poisons, and vitiated air arising from +effluvia from persons in disease, and from their excretions. + +From this circumstance, these principles, viz. specific contagious +poisons, and vitiated air arising from persons in disease, have been +erroneously classed together, and a supposed analogy has been created. + +But these principles are widely different in their nature, and in the +laws by which they are regulated. + +The specific contagious poisons produce the same diseases as those with +which the bodies, whence they arose, were affected, and them only; and +their operation is marked by uniform effects, observing stated and +unvarying periods. Vitiated air, of the kind under examination, though +it arises from persons in a state of disease, and is sometimes known to +operate in the production or propagation of the same distemper, does not +always induce disease, does not induce that disease only, whence it +sprung, but various others; and, in short, its effects are not uniform, +and do not observe stated and unvarying periods. + +The specific contagious poisons produce their peculiar diseases, as +their proper and only effects, without the cooperation of other +influences; but vitiated air, when the same disease extends, whence it +arose, cannot be said to be causing its proper, only, and peculiar +effects, as the same disease does not invariably follow its action. In +general, the effluvia which proceed from a sick person, where they prove +hurtful, cause the same distemper as that with which he is affected; for +instance, the effluvia arising from a person affected with typhus fever, +produce that disease again:—but that is not always the case, and an +instance will be presently detailed, where the effluvia which proceeded +from a body dead of one disease, produced another of a very different +nature. + +The reason that the presence of vitiated air is generally attended with +the same disease as that with which the body is affected, whence it +sprung, is, that there is existing at the time, a disposition to that +particular malady: and the vitiated air only gives it form by acting as +an ordinary exciting cause upon individuals prepared for its invasion. + +It appears probable that vitiated air, unlike the palpable contagious +poisons, assists in the production of that disease only which is +prevailing, or to which there exists a disposition from the operation of +other agencies; and it appears probable that vitiated air, whether it +arises from persons affected with this or that disease, will, within +certain limits, produce one disease as readily as another, the required +particular disposition being present; for instance, that the effluvia +from a small-pox patient will induce small-pox or typhus fever, +according as there exists a disposition to the one disease or the other, +and _vice versa_. + +The effluvia arising from newly opened graves have been often productive +of putrid fever. + +The following case will shew that effluvia arising from the remains of a +person who died of consumption of the lungs, and not of small-pox, +produced that disease, viz. small-pox. When that case occurred, +small-pox was prevailing, and doubtless, had there been existing at the +time a disposition to putrid fever, that disease, and not small-pox, +would have been induced by the effluvia which arose from the grave. + +In September 1834, Peter Macawley, about twenty-eight years of age, +gardener and grave-digger, was employed in the churchyard of Tranent. +While busily digging a grave, he unexpectedly struck a coffin with his +spade, and broke it open. The coffin contained the remains of an old +woman, who had died of consumption of the lungs, and who had been +interred about fourteen months. + +There immediately issued from the coffin the most offensive effluvia, +which threatened suffocation, and made him feel very unwell. + +He proceeded home, and continued throughout the night very poorly, +giddy, and uncomfortable. He rose next morning, and although no better, +proceeded to the churchyard, gave some directions, and returned home, +feeling giddy and unsteady. He was put to bed, and passed a very +uncomfortable night. + +Called in next morning to prescribe for him, I found him to be affected +with severe pain of head, great heat and sweating of skin, and great +quickness of pulse. He complained of thirst, could take no food, and was +occasionally delirious. On the third day of his illness, pimples +appeared over the whole surface of the body, which gradually becoming +larger, assumed the form of small-pox. The pocks or pustules did not +mature or fill with matter in the usual way, but continued throughout to +be flat, and assumed a dark blue or inky colour. + +His strength fast declined,—he became very low,—muttered incoherently to +himself, and symptoms of a putrid character supervening, and the +energies of the system fast failing, he died insensible about the +twelfth day of his illness, of the worst form of immature, putrid, +confluent small-pox I had ever witnessed. + +He was a powerful, well-formed, and laborious man, was in good general +health up to the moment of his being affected in the grave,—and it was +not ascertained that he had been in a situation to receive infection +from any other source. + +Vitiated air arising from persons in a state of disease, is found in +those situations only where the apartment is close and confined, where +the person and clothes are allowed to remain in a state of impurity, +where the secretions and excretions are left to ferment; and, in short, +where no attention is paid to cleanliness, the removal of respired air, +and the introduction of a fresh atmosphere. The production of vitiated +air is thus only occasional, while, in the contagious diseases, the +specific poisons are produced in every case of their respective +diseases, and were they capable of being diffused in the atmosphere, +there would be present as constantly an atmospheric contagion. + +When vitiated air is produced, its removal can readily be accomplished, +as daily experience, and the testimony of Dr Haygarth, given at the +beginning of this work, amply prove. + + + AIR VITIATED WITH EFFLUVIA FROM DEAD ANIMAL MATTER. + +There is still another source whence effluvia of a pestiferous nature +arise. Dead animal matter, during putrefaction, exhales gases which +taint the atmosphere, and render it unwholesome. + +When these materials are exposed to heat and moisture, the decomposition +is rapid, and the air becomes more obviously tainted than when that +process is retarded by cold, breezy weather, and some other +circumstances. When the decomposition takes place in the open air, and +when that is kept in motion, the quantity of decomposing materials not +being very great, the bad effects are not so serious. + +When, however, buried along with a sufficient quantity of atmospheric +air, to allow of the play of the chemical affinities, and kept there a +considerable time, if they be exhumed previous to their total digestion +or complete assimilation with surrounding objects, effluvia are exhaled, +having the most intolerable stench, causing instant sickness, faintness, +and giddiness, and eventually producing disease. + +“Thus, we are told by Fourcroy, that in some of the burial-grounds of +France, whose graves are dug up sooner than they ought to be, the +effluvium from an abdomen, (belly), suddenly opened by the stroke of the +mattock, strikes so forcibly upon the grave-digger, as to throw him into +a state of asphyxy, if close at hand; and if at a little distance, to +oppress him with vertigo, fainting, nausea, loss of appetite, and +tremors for many hours: whilst numbers of those who live in the +neighbourhood of such cemeteries labour under dejected spirits, sallow +countenances, and febrile emaciation.”[5] + +Footnote 5: + + Good’s Study of Medicine, vol. ii. page 65. + +Instances are likewise known where graves containing human bodies, long +dead of plague, upon being opened, have emitted effluvia, which have +produced typhus fever among the workmen. + +It is probable that, in general, the effluvia arising from dead animal +materials, undergoing decomposition in the ordinary way, are the common +results of the putrefactive fermentation,—carbonic acid gas, hydrogen, +nitrogen, &c. + +These gases form various combinations; carbonic acid gas and hydrogen +gas forming carburetted hydrogen, an inflammable gas, the same as is +used for the purpose of illumination, and which cannot support +respiration. Hydrogen unites with nitrogen, and forms ammonia, or spirit +of hartshorn, which is volatile, and imparts a strong odour to the +atmosphere, such as is experienced in stables and byres, producing +sneezing and watering of the eyes. + +Hydrogen, at its extrication, sometimes carries with it a portion of +phosphorus, already contained in the decomposing body, and becomes +phosphuretted hydrogen, a gas which ignites spontaneously in the +atmosphere, the same that is sometimes observed in churchyards under the +title of corpse-lights. + +Hydrogen sometimes also unites with sulphur, and the combination is +called sulphuretted hydrogen, a gas readily discovered by its offensive +odour,—which it imparts to many very useful mineral waters. + +These gases are discovered, not only in an atmosphere exposed to +decomposing dead animal materials, but are also found in that atmosphere +containing numbers of men in health, closely crowded together, and +persons suffering putrid diseases, where no attention is paid to +cleanliness and the removal of impurities. + +A body affected with putrid disease is more liable to decomposition than +one in health; and the secretions and excretions are more prone to +putrefaction, and the emission of effluvia or gases. + +Some facts are known, which shew that bodies, in some forms of low or +malignant disease, both before and after death, possess a virulence, +never found in bodies in health, or affected with disease of a +non-malignant character. The worst consequences have followed wounds in +the dissection of bodies recently dead of typhus fever; the +introduction, under the skin, of the fluid contained in the petechiæ or +black spots common in that disease, and even the washing of bandages and +clothes employed in cases of mortification and the like. + +In such diseases, the body becomes a very centre of contamination and +virulence; its fluids become acrid and poisonous; and on the surface of +the body, fluids are elaborated, which are productive of the most +malignant and pestiferous effects. Whether these fluids, those virulent +secretions, are ever diffused in the air, and impart to it their deadly +properties, is a point of much interest, but one which cannot be +entertained here. + + + + + CHAPTER VI. + AIR VITIATED BY ADMIXTURE WITH EFFLUVIA ARISING FROM THE DECOMPOSITION + OF VEGETABLE MATTER ON THE SURFACE OF THE EARTH. + + +It is not only from such sources as those already treated of, that +effluvia or gases arise, to contaminate the atmosphere, and to spread +disease among men and beasts. Effluvia likewise spring from the +putrefaction of vegetables; and, in many instances, from circumstances +favourable to their development and action, they so vitiate the +atmosphere, that its respiration induces some of the most virulent +diseases, and, where the effects are not so serious, a state of slow +sickness and great suffering is often the lot of the sufferer, during +the whole course of his miserable existence. The situations of these +effluvia will shortly be pointed out, along with the respective diseases +incident to them. + +But let us for a moment consider the changes on which these effluvia +depend. Putrefaction of vegetable matter is one of the many wise +provisions which the Almighty has instituted for the accomplishment of +his comprehensive plan of the creation. + +The surface of the earth is covered with vegetation, to supply man with +food, and likewise to support the various animals placed below him in +the scale of creation, so necessary to his comfort and existence. They +are consumed, and, by means of digestion, become component parts of +animals; and when these, in their turn, die, they go down to the earth, +whence they originally sprung. + +Mixed there, with other matters composing the soil, the carcasses of +animals afford nourishment to vegetation again, and once more they are +found as the component principles of vegetable forms. Thus the animal is +constantly supplying food to the vegetable world, which, in its turn, +supplies food to the other again. + +In life, we found them performing functions useful to each other, and +mutually correcting their unwholesome effects; in death, they are no +less useful: the one is converted into the other. + +All animated creation is the scene of endless changes, and is the object +of successive transformations. ’Tis one mighty circle, of a thousand +parts, constantly revolving,—one part occupying now this, now that +place,—and each taking the place of that next it, till at length it +completes the entire circle; and even then the race is not yet run, the +revolution must be performed again and again, to the very end of time. + +The immediate agency by which these wonderful changes are effected, is +putrefaction. We have alluded to it shortly, in connection with man in +health, in disease, and in death. + +We have now to speak of putrefaction in connection with dead vegetable +matter, in marshy situations, &c., where it is the occasion of much +disease. + +There is no reason to believe that it was the design of the Almighty, +that the process of putrefaction, which is so essential to the great +plan of successive races of animals and vegetables, should be the active +engine of pestilence, which it is in many situations. + +That is not the necessary consequence of putrefaction; and when it does +occur, it is rather the effect of accidental circumstances. Under +ordinary circumstances, where putrefaction goes on, as among vegetables +moderately moist, exposed to currents of air, and mixed up with the +soil, as in the various processes of agriculture, no bad results are +experienced. + +But when vegetation is allowed to go on year after year, without being +cropped, where, as it ripens, it withers and dies; and when it dies, is +allowed to accumulate and putrefy, where there is much moisture, much +solar heat, and little motion of the air, where, perhaps, other +circumstances are operating, favourable to rapid decomposition, effluvia +are wont to ascend and vitiate the atmosphere. + +Such a vitiated atmosphere has acquired various appellations, according +to the place in which it has been observed, and according to the effects +or diseases it produces. + +But, under whatever name it passes, its origin is the same, namely, +decomposing vegetable matter on the surface of the earth, perhaps, in +some situations, mixed more or less with dead animal matter. + +It is decomposing vegetable matter which produces the yellow fever of +the West Indies, the jungle fever of India, the deadly pestilential +fever of the coast of Africa, the ague in this country and in many +others, the cretinism of Switzerland, the pellagra of Milan, the +unwholesome condition of humanity in many parts of Italy, and especially +in the country surrounding Rome, or the Campagna of Rome, as it is +called. The decomposition, however, takes place under circumstances +somewhat different, and hence the difference in the results of its +action. + +These effects are attributed to the decomposition of vegetable matter; +but there is room to think that, along with that, there is combined no +very insignificant proportion of matter of an animal nature. + +It may safely be inferred, that wherever there is vegetation, there +animals are found also; and it is well known that vast numbers of many +kinds of animals live wherever decomposition is taking place, especially +if the situation is warm and sheltered. The carcasses of these animals +will be added to the vegetable matter, and add to the common mass of +corruption. + +That matter in swamps, and in unwholesome situations, said to be purely +vegetable, is then a compound of animal and vegetable origin; and these +effluvia arise, not from vegetable decomposition only, but from both +dead animal and vegetable substances in a state of putrefaction. + +There is little known of the composition of these effluvia. We are most +conversant with their situations, and their effects upon health. In +different situations, they produce different diseases. But no known +facts entitle us positively to say that their composition is different. +It is a remarkable fact, but one well ascertained, that the atmosphere, +in all parts of the world, in all climates, and in all situations, is +much the same in its chemical composition. It manifests the same general +physical characters in all situations, whether healthy or pestilential, +and the nicest investigations have detected nothing in an atmosphere +known to be pestilential, that is not found in the most wholesome. + +However, there is much reason to think, that this circumstance is owing, +not to the absence of hurtful gases, but to the comparative +insignificance of their volume beside that of the atmosphere itself, so +vast in its dimensions. + +Medical men have been disposed to think that effluvia which cause one +disease, say the yellow fever, are not the same as that which cause +another, say the fever of the coast of Africa. The only reason offered +is the difference of the diseases; but that is not enough to prove that +the effluvia are different in their nature. Different effects, or +effects so modified as to appear very different, are the results of the +same cause on many occasions. The smoke of tobacco will make one person +feel comfortable, another merry, another sick, another faint, and so on; +but it would be unfair, from these differences in the effects, to +pronounce that tobacco-smoke was in all these cases different in its own +nature. + +We are satisfied that the effluvia or gases arising from marshy or +unwholesome soil, are the same, generally speaking, in all situations, +whatever disease is produced; and that the difference in the results is +to be attributed to the varying circumstances under which they act,—for +instance, the constancy or inconstancy of their operation, their greater +or less intensity, the greater or less degree of concomitant moisture +and heat, the greater or less amount of motion of the air,—the sheltered +situation of human habitations,—the condition of the body, its +predispositions from native country and the like, and the individual +being accustomed or unaccustomed to the action of effluvia. + +Gases are known to arise from the marshy grounds mentioned, where animal +and vegetable matter is putrefying, from the fact, that the +neighbourhood of swamps is most unwholesome, the inhabitants and +visitors almost uniformly suffering, because unwholesome effluvia are +invariably known to emanate where animal and vegetable matter is thus +corrupting, and because the gases themselves may be seen rising in +bubbles out of putrid water, containing dead animal and vegetable matter +in a state of corruption. + +These bubbles contain gases the very same as are disengaged when animal +and vegetable matter are putrefying among water. They are nearly the +same as proceed from merely animal matter dead and putrefying, not +incorporated with the soil, viz. carburetted hydrogen, or inflammable +gas, carbonic acid gas, or fixed air, and sometimes a little +phosphuretted and likewise sulphuretted hydrogen. + +These gases are sometimes appreciable to the organ of smell. Carburetted +hydrogen is very strong, and is perceptible in many situations where +there is much corruption going on; for instance, at the meadow-ground +between the Dairy, on the Portobello road, and Comely Green, near +Edinburgh, where the stench is so strong as to prove most offensive to +passengers on the road. The source is the corrupting animal and +vegetable materials, in the foul water conducted from Edinburgh, and +made to overflow the ground, for the purposes of irrigation. + +In such situations, it is not uncommon to observe lights floating along +during the night, and superstition has not failed to make them represent +evil spirits. They are known by the name of “Will o’ Wisp” and “Jack o’ +Lantern;” and have, on many occasions, proved objects of no slight dread +to many ignorant persons. The lights are merely ignited carburetted +hydrogen gas,—the same kind of gas as that used for lighting our shops +and houses. + +The gas is ignited, perhaps, by the rising to the surface of the putrid +water, of a bubble of phosphuretted hydrogen, which, as was before +observed, burns the moment it comes in contact with the atmosphere. + +Other products of an aeriform kind may be evolved also, but we have no +direct evidence of their existence,—but an atmosphere, loaded with +vapours of the kind mentioned, is enough to account for the production +of the observed disease, in all its varied forms, when there is +conjoined with it other unwholesome agencies. In some countries, the +pestilential air is present throughout the year, for instance, in the +country around Rome, in the fens of Lincolnshire, where ague is seldom +absent; in others it is periodical, chiefly confined to the hot and +rainy seasons, as in India and in the West Indies, where fevers prevail +to a great extent; and in others, again, it is observed only when the +wind blows from a particular direction. + +These effluvia are conveyed to a distance by currents, and produce their +peculiar effects, more or less, upon almost all they encounter. The +malaria at Rome is carried by the wind into the city, by the channels +most open to its entrance; and those parts, it is said by medical men +who reside there, that are most exposed to the wind blowing off the +adjacent marshy grounds, are most unhealthy. It is for that reason that +the suburbs are more unwholesome than the interior of that city, where +the wind does not find ready access, on account of the obstacles offered +to its course by the high buildings. The high houses and streets thus +act as a barrier against the entrance of the pestilence, and it is even +said that the narrowest streets there, are the most healthy, as they +shut out the pestilential vapour. + +An obstacle of the same kind is offered by hills which interrupt the +course of winds carrying with them vapours from marshy grounds. In the +West Indies, where the yellow fever commits such frightful ravages, many +instances are known where a town or district retains its health, from +the shelter which a hill affords against the visitation of a wind that +has loaded itself with deadly miasms, while sweeping over a marsh or +swamp. It is the practice of those residing in those countries, not only +to remove from the swamps, but also from those points to which the wind +blows after passing over them. + +Inattention to that consideration has led to the loss of much human +life, and to the fruitless expenditure of much money in the erection of +houses, barracks, and the like, which, after completion, have been found +to be totally uninhabitable, from the pestilential vapours carried to +them by the winds. In illustration of the influence of winds, we submit +the following interesting extract from Dr Good’s Study of Medicine. He +has been speaking of effluvia from animal matter. “But the foul and +stinking Harmattan,” (a pestilential wind) “when it rushes from the +south-east upon the Guinea coast, loaded with vegetable exhalations +alone, with which it impregnates itself while sweeping over the immense +uninhabitable swamps and oozy mangrove thickets of the sultry regions of +Benin, triumphs in a still more rapid and wasteful destruction; so much +that Dr Lind informs us, that the mortality produced by this +pestilential vapour in the year 1754 or 1755 was so general, that in +several negro towns, the living were not sufficient to bury the dead; +and that the gates of Cape Coast Castle were shut up for want of +sentinels to perform duty. Blacks and whites falling promiscuously +before this fatal scourge.” + +So loaded is the air on some occasions with these pestilential vapours, +that they attach themselves to whatever objects they meet, houses, the +sides of hills, and woods, through which they pass along with the wind, +and so completely has a wood stripped the currents of their baneful +accompaniments, that they have been respired after with no injury +whatever. + +Trees are found to give great shelter and salubrity to towns in this +way, acting as they do as so many sieves retaining impurities. + +It is understood that the effluvia arising from putrefying vegetable +matters ascend high in the atmosphere under the influence of the solar +rays, and spread far and wide, and that at night during the cold they +fall with the dew to the ground again, and impart to it and to those +exposed to its action, much virulence. The ground is there known to be +extremely unwholesome, and those who have been compelled by want, by +sickness, while travelling, overtaking them, or by being benighted, to +lie down with nothing but the soil for a couch, and with no shelter from +the vapours and dew that falls at night, save the sky itself, have felt +this pestilential influence: on the morrow they awake distressed, +parched, and affected with headach, and the usual symptoms of malignant +fever. + +With the close of day or the setting of the sun, the pestilential vapour +falls and envelopes the country and the habitations of men with a deadly +mantle—and it is then unsafe to venture into the open air in many of the +finest countries of the world. + +The pestilential effects of exposure to these night dews and vapours +have, on many occasions, been experienced by soldiers encamping in the +open grounds, and our gallant countrymen on foreign service are wont to +yield in fearful numbers to a foe, merciless and unsparing. + +But it is not in swampy grounds only that these vapours arise, for there +is reason to think that in those places where sickness is constant, and +where no such dampness of ground is observed, that decomposition of +animal and vegetable matter is going on some depth below the surface, +and that the extricated gases issue through the soil. This is rendered +almost certain, by the fact which has sometimes been observed, that the +most dangerous and sickly season is, when the ground is parched and rent +with heat, permitting the exhalations generated below to ascend into the +atmosphere. Instances of this occurred among our soldiers in the +Peninsular war—the season, marked with the greatest prevalence of +disease, the common result of vitiated air, being that when the soil was +most rent with heat. + +In some parts of Italy, it is remarked by that eminent physician and +philosopher, Dr James Johnstone, in his admirable volume, entitled the +Diary of a Philosopher, which, by the way, is a work of rare virtue, in +so much as it is replete, not only with accurate medical knowledge, but +with reflections in literature and the fine arts such as prove an +intimacy with polite learning not always found, that fever and that +general unwholesome state of body, observed in districts infested with +vitiated air, prevail where inquiry has discovered no appearance of +unusual dampness and corruption of the soil. He thinks that streams of +putrid water, containing animal and vegetable materials, that have sunk +down from the surface, in some part of their course are making their way +at a little depth, and that when the soil, parched with excessive heat +and drought, becomes rent, as it commonly does, the emanations +previously confined rush out by the channels now presented by these +fissures, and deal their deadly effects around. + +Such an explanation seems to me highly probable, and deserving of more +inquiry. Connected with this subject, the following facts may be +interesting, and assist in forming an estimate of the probability of the +truth of that explanation. + +In mines, as well as on the surface of the earth, changes are constantly +going on; and as in the latter situation the animal, vegetable, and +mineral components of the soil are decomposing, so the minerals in the +former are giving out some of their component parts and abstracting +oxygen, &c. in turn from the atmosphere. + +In mines some of the fossils attract oxygen from the air, but the chief +process by which the atmosphere becomes vitiated there, is by the +evolution of gases from the minerals. In coal pits the principal gases +emitted are carbonic acid gas, commonly known as fixed air, which will +support neither animal life nor combustion, as proved by the disastrous +results on men having been confined in it, and by the extinction of +light when immersed therein, and carburetted hydrogen gas, known as +fire-damp, which cannot support respiration, and which takes fire when +brought in contact with a light. These gases are the results of chemical +changes going on in the minerals, in the same way as the gases before +alluded to attend the decomposition of animal and vegetable substances. + +These gases arise not only from the minerals exposed to view at the +various surfaces, as the roof, sides, and pavement of coal pits, but +issue also from the unworked minerals in the interior, by fissures or +cracks in the various strata, produced by the violence used in detaching +the minerals. + +These fissures extend in the course of the beds, or strata, and are +often scarcely visible, but are sometimes so wide as to admit the +finger. It is probable that they sometimes extend a considerable way +into the solid minerals. + +In general, from these fissures there is constantly issuing streams of +gas, of a nature varying with the character of the minerals, but for the +most part they are such as have been mentioned. In the mines of Great +Britain, when the atmosphere above is much agitated, as by the +prevalence of southerly winds, and more especially if the violence +amounts to what is termed a storm, the gases pour out in prodigious +quantities, making a rushing noise, and filling the pit and excavated +parts. The pit then becomes so full as to interfere with the operations +of the men, who are frequently, for their safety, obliged to retire. In +this case the atmosphere is lightened, and the pressure it is constantly +exerting on all bodies with which it comes in contact is diminished, and +the consequence is, that the gases rush out, under the circumstances +already mentioned. It is known, that, during the prevalence of stormy +weather, the mercury in a barometer falls; it is for a like reason, the +weight upon it being less. Not only the gases issue from their caverns +when the air is thus lightened, but water contained in fissures in the +floor or pavement of mines rises also, sometimes to the amount of an +inch or two, and it is no uncommon thing to see the extrication of +vapour from a little collection of water on the floor, such as takes +place when water is boiling, a movement which it very much resembles. + +These facts shew that it is not improbable that pestilential vapours, +ordinarily passing under the soil, may be extricated when fissures are +present. It may happen that effluvia may be prevented from issuing even +when fissures exist in the soil, from an increase in the weight of the +atmosphere, and in this way may be explained the occasional +disappearance of pestilence with a change of weather, not unfrequently +remarked in some tropical countries. + +During the prevalence of strong north, north-east, and north-west winds, +blowing with considerable violence the currents in mines are +reversed—for, instead of gases issuing from the fissures and crannies, +currents of atmospheric air pour into them. These currents may be felt +with the hand, and the ear can detect the rushing sound; a flame applied +to a fissure is immediately drawn in, shewing the direction of the +current. These facts illustrate the influence which the state of the +atmosphere has upon terrestrial vapours. + +As has been already observed, the exhalations from the soil obtain +different names from the effects they are wont to produce. When they +produce intermittent fever or ague, they are termed marsh miasms. When +they produce the various forms of malignant fever, such as the yellow, +the bilious fever of India, and the coast of Africa, simply pestilential +effluvia—and when they induce general bad health and degeneracy of the +inhabitants of a country, they are styled malaria, an Italian expression +signifying bad air. + +As the subject appears one which may interest the general reader, it is +proposed to add a few observations on the diseases which are caused by +air vitiated with effluvia from the soil. + + + + + CHAPTER VII. + MALIGNANT FEVER. + + +A vast proportion of the most virulent diseases to which the human race +is subject in almost all parts of the world, but more especially in +tropical regions, is produced by the action of effluvia arising from +decomposing dead animal and vegetable matter on the surface of the +earth, and incorporated with the soil. These effluvia are the immediate +instrument by which thousands of our fellow men are annually deprived of +existence, the career of the young and the robust is abruptly stopped, +never again to be renewed. Malignant fever is the disease, by which +death is occasioned from these effluvia; and this fever assumes forms, +characters, and titles, various and manifold. It ravages in almost every +country within the tropics, and in many situations it annually commits +the most dreadful havoc—cutting down so rapidly that the ordinary forms +of burial cannot be observed. Whole communities suffer, the inhabitants +of a particular tract of country are sometimes almost extirpated, and to +visit some countries is almost to incur death from pestilence, so near +to certain is attack, and its destructive character is so uniform. + +The average duration of life in many countries is extremely low, chiefly +on account of the wasteful career of that scourge, under its various +characters and designations; and it is not saying too much that there +the number of deaths is four times as great as occurs in our own happy +country. + +In those regions in which malignant fever prevails so much, almost every +inhabitant at one period of his life, sooner or later, is afflicted with +it. If he survive he is more fortunate than thousands of those who lived +beside him; but his health is often deteriorated, he is often deprived +of that vigour and elasticity both of mind and body, which spring from a +sound constitution, and he not unfrequently lingers under the sufferings +of chronic disease till his life is gradually though slowly exhausted; +unless, indeed, as often happens, it is suddenly terminated by a fresh +attack of the active pestilence. + +“Almost every territory in which it (malignant fever) has committed its +ravages has given it a new name. It is as gorgeously arrayed with titles +as the mightiest monarch of the East. From the depredations it has +committed in the West Indies, and on the American coast, it has been +called the St Domingo, Barbadoes, Jamaica, and American fever; and from +its fatal visitations on the Guinea Coast, and its adjoining islands, +the Bulam fever. In British India it is distinguished by the name of +Jungle fever, and still farther to the east by that of Mal de Siam. +Nearer home, in the lowlands of Hungary, and along the south of Spain, +it is called the Hungarian or the Andalusian pestilence. From its rapid +attack on ships’ crews, that are fresh to its influence, the French +denominate it Fievre Matelotte, (fever of sailors) as the Spanish and +Portuguese call it vomito Prieto or black vomit, from the slaty or +purplish and granular suburra (grounds) thrown up from the stomach in +the last stage of the disease; while, as its ordinary source is moist +lands, it has frequently been named Paludal Fever.”[6] + +Footnote 6: + + Good’s Study of Medicine, vol. ii. p. 145. + +This fever is severe with new settlers in these countries. Persons +visiting places in which it is endemic, during its severity almost +necessarily suffer, but sometimes they escape with a slight attack, in +which case they are said to have had a “seasoning fever.” The +pestilential vapours may be carried to a great distance, by winds and +currents. Instances have already been given where districts are +immediately rendered unhealthy upon the visitation of a wind which has +passed over an unhealthy swamp at a distance. Many instances are also +well known where ships, riding at the distance of a league from an +unhealthy coast, have had their crews affected with the distemper, on +the vapours being sent among them by the wind coming off that direction. +The British navy is, alas, too familiar with instances of ships being +visited by that pestilence when lying off the coast of Africa, where, +too, no direct communication had been maintained. The most appalling +mortality occurs in these cases; it is not unusual during the short +period a ship remains on that station for the whole officers and crew to +be swept away in one general tide of death, and it not unfrequently +happens that, after the short space of three years, the ordinary time of +service, that when a ship returns to England, she has not a hand on +board she carried out—but is manned with a crew that has succeeded one +which had, in its turn, taken the place of that which danced in joy, and +looked all gallantry, only a few short months before, when with hearty +huzzas they left their native land, and committed themselves to their +bark and to the buoyant billows. At the time of the expedition to +Walcheren a disastrous state of health prevailed among the soldiery in +Holland, in consequence of vitiated air and other forcible +adjuvants;—the pestilential vapours which arose from the soil were borne +by the winds to the ships riding at a distance, and there fever failed +not to manifest itself with its usual severity. + +The actual amount of mortality produced by pestilential effluvia from +the soil has never been accurately calculated in those countries where +they are most severe. No bills of mortality or registers of deaths are +kept, as in this country, in connection at least with the natives. But +enough is known to shew that the amount is prodigious. + +Tables are kept of the deaths occurring among the soldiers belonging to +this country, serving on foreign stations, and they amply shew that the +mortality is frightfully greater in those countries infested with these +effluvia, and with the diseases which these effluvia are wont to excite, +than at home—and as they are the chief agency of an unwholesome +character, known to prevail in these regions, it is not unfair to +attribute to them, in a general manner at least, a very great proportion +of the excessive mortality. + +The following extract, from an official return, will shew the greater +mortality among the military when serving in the British Colonies than +when stationed at home— + + _Official return of the mortality among officers and soldiers in the + several British Colonies, chiefly for the seven years from 1820 to + 1826, shewing the annual deaths out of ten thousand men._ + + Great Britain (1824 and 1826), out of 10,000 there died per annum, 144 + Mauritius, 240 + Madras Civil Service in 1820, 600 + Ceylon, soldiers on the island, 1328 + West Indies, 701 + +Such is the fearful mortality which occurs among our soldiers stationed +in some of our colonies, where effluvia of a pestilential character +exhale from the ground. In Ceylon, where terrestrial effluvia are known +to prevail, the number of deaths of our soldiers is more than nine times +that which occurs among those who are stationed in Great Britain. + +The immediate cause of that frightful mortality is the malignant fever, +the chief agent in whose production, again, is the pestilential +atmosphere, rendered such by terrestrial effluvia, and not by the +presence of specific contagious poisons, as defined at page 105, +assisted, perhaps, by other hurtful influences, such as, the intemperate +habits which new comers in those colonies frequently adopt, the great +heat of the climates, operating with particular force upon those +accustomed to the more temperate climate of England. + +This pestilential fever, the product of effluvia from the soil, commits +such mortality among our gallant soldiery, as throws into insignificance +the carnage attendant on active warfare, as renders that, even in the +field of battle, comparatively of little moment. + +Men in action may fall fast around; whole lines, nay columns of living +humanity, its boldest samples, in one brief moment may be hewn down; +still, as such carnage can last but a few hours of the day only, or, if +protracted, a few days at most, the work of death is inconsiderable, +compared with that effected by pestilential effluvia in many situations, +operating both night and day, from day to day, and from year to year, +unceasingly. + + + + + CHAPTER VIII. + GENERAL DISEASED CONDITION OF THE BODY, THE PRODUCT OF MALARIA. + + +The inhabitants of countries infested with malaria, or vitiated air, +when they have been spared the more acute forms of disease, or have +recovered from them, are generally the victims of a miserable state of +health, compared with which many conceive that death itself would be +preferable. + +The body loses its vigour and aptitude for exertion, becomes weak, +disabled, sluggish, and impotent; the appetite fails: the limbs refuse +to carry their burden aptly so called, and they become swollen and +dropsical. The mind becomes lethargic and unfit for exertion, and the +unhappy sufferer, who is insensible to whatever gratifies his more +highly favoured fellow-men, becomes often weary of existence, a burden +to himself, and an object of pity to others, who are accustomed to +regard the activity, the cheerfulness, and graceful lineaments of +health. + +Thousands are so afflicted; and the number of those who thus have their +existence embittered,—who are deprived of the manifold enjoyments which +our condition can afford, and whose lives are prematurely terminated,—is +even greater than that of those who die of the more violent and more +speedily mortal distempers which are induced by vitiated air. + +“A glance at the inhabitants of malarious countries or districts, must +convince even the most superficial observer, that the range of disorders +produced by the poison of malaria is very extensive. The jaundiced +complexion, the tumid belly, the stunted growth, the stupid countenance, +the shortened life, attest that habitual exposure to malaria, saps the +energy of every bodily and mental function, and drags its victim to an +early grave. A moment’s reflection must shew us, that ague and fever, +two of the most prominent features of the malarious influence, are as a +drop of water in the ocean, when compared with the other less obtrusive, +but more dangerous, maladies that silently but effectually disorganize +the vital structures of the human fabric, under the operation of this +deleterious and invisible poison.”[7] + +Footnote 7: + + Johnson’s Diary of a Philosopher. + +Such is the general state of health of the inhabitants of many parts of +the world; but it is chiefly in some parts of “fair Italy,” whose +celebrated blue skies invite, whose luxuriant vegetation delights, whose +gay and extensive prospects ravish, and whose classic associations charm +the ecstatic spectator,—where humanity acquires that degenerate +character, and that hideous aspect, which it assumes as if on purpose to +mark the contrast between the gay revelry of vegetation, and the +revolting degeneracy of mortality. + +The resident in Italy can scarcely escape entirely the action of +malaria; if he survive or escape the more immediate and more violent +effects, those just described are, in the course of time, almost sure to +manifest themselves. + +Many of our countrymen make their residence in Italy, invited by its +sky, its sun, its fertility, its ancient monuments, and stirring +associations, and they not unfrequently prolong their stay so much as to +imbibe the seeds of general bad health, which, though it may not +develope itself at the time, will manifest itself at some future day. +The malaria of Italy, like that of some other countries, sometimes acts +slowly, and does not produce its effects, until the sufferer is again +resident in his native country. Assailed with general decay, he is at a +loss to know its cause, happening, too, at a time, when he had expected +that his general health would have been more than ever established by +his residence in a warmer climate, and under a clearer sky. It is a +remarkable feature in the general bad health thus produced, that it is +marked with periodical alternations of activity and repose, or with +aggravations and remissions. + + + CRETINISM. + +Cretinism, by which is meant a degenerate state of body, and an imbecile +state of mind, which occurs for the most part in the valleys of +Switzerland, and among the hollows of the Alps and the Pyrenees, and +that is in a great measure the product of vitiated air, emanating from +the swampy valleys and basins, which contain animal and vegetable +materials, powerfully acted upon by the direct and reflected rays of a +burning sun. + +From the mountains there pour many streams into the valleys or troughs +beneath, and, as the water is seldom completely carried off, it there +forms an excellent or very favourable nidus for the putrefaction of +animal and vegetable remains. + +It is said, by those who have attentively observed the miserable +population in these regions, that they form the most humiliating picture +of humanity. The body presents the most loathsome condition, and the +mind is removed only a step from idiocy itself. + +The unwholesome tendency of these terrestrial vapours is materially +increased by the almost incredible filth in which the inhabitants keep +their persons, clothes, houses, and streets, the effluvia of which alone +are almost intolerable and most offensive. + +The general degeneracy of the body is frequently accompanied with a +large swelling at the front of the neck, which gets the name of +“Goitre,” and which is known in England under the appellation of +“Derbyshire Neck.” + +Cretinism has prevailed in Switzerland for many centuries, and has been +likewise noticed among the mountains of China. + +Cretinism is thus ably described by Dr James Johnson: “The stature is +seldom more than from four to five feet, often much less;—the head is +deformed in shape, and too large in proportion to the body;—the skin is +yellow, cadaverous, or of a mahogany colour, wrinkled, sometimes of an +unearthly pallor, with unsightly eruptions;—the flesh is soft and +flabby;—the tongue is large, and often hanging out of the mouth;—the +eyes red, prominent, watery, and frequently squinting;—the countenance +void of all expression, except that of idiotism or lasciviousness;—the +nose flat;—the mouth large, gaping, slavering;—the lower jaw +elongated;—the belly pendulous;—the limbs crooked, short, and so +distorted as to present anything but a waddling progression;—the +external senses often imperfect, and the Cretin deaf and dumb;—the _tout +en semble_ of this hideous abortion of nature presenting the traits of +premature old age. The Cretins are voracious, and addicted to low +propensities. To eat and sleep form their chief pleasures. Hence we see +them, between meals, basking in nonchalance on the sunny sides of the +houses, insensible to every stimulus that agitates their more +intelligent fellow-creatures.” + +Before closing this sketch of the effects of malaria in Italy, a table +of the annual decrement of life is submitted, which will shew the +fearful mortality of that country over that of England, the +disproportion against the former country being owing, in a very great +degree, to the contamination of the atmosphere, caused by the effluvia +which arise from the soil. + + In Rome, 1 out of every 25 persons dies annually, or a 25th part of + the whole population. + + In Naples, 1 out of every 28 persons dies annually, or a 28th part of + the whole population. + + In England, 1 out of every 60 persons dies annually, or a 60th part of + the whole population. + +Thus, in England, the mean term of life is more than double what it is +in Rome or Naples; and thus, while it takes 60 years to extinguish a +generation in England, the brief period of 25 years completes the same +work at Rome. + + + INTERMITTENT FEVER, OR AGUE. + +Intermittent fever, more familiarly known as ague, is also a common +product of air which is vitiated with effluvia arising from the soil. + +That disease was much more prevalent some years ago in England than it +is at present, where it is almost confined to Lincolnshire, and some of +the low grounds and meadows of Kent and Essex, through which the Thames +flows. + +It is unnecessary to mention the symptoms of ague, as they are +familiarly known. Convalescents are very liable to relapses, and many of +those who have recovered from the more violent symptoms, are frequently +affected, throughout the whole term of life, with very troublesome +complaints, which arise from what is vulgarly known as ague cake, which +is an enlargement of the spleen, an organ which lies near the stomach. + +Ague is very prevalent in the West Indies, America, Holland, and other +countries which are much covered with wood, are ill drained, and liable +to be periodically inundated. This disease displays none of the +virulence of the malignant remittent fever already noticed, yet affects +vast numbers in its peculiar localities, and not unfrequently leads to +mortal results. + +The whole population of those fens and swamps in which ague is endemic, +is generally affected at some period of existence, scarcely one person +escaping. + +The effluvia which produce that disease are sometimes carried to a +considerable distance, and there induce their peculiar distemper; and +instances are well known, where effluvia have been conveyed to high +grounds, where they have attacked the inhabitants, while those in the +immediate neighbourhood of the source of these vapours, have escaped for +the time. + +Ague is a much milder disease than the remittent fever, which springs +from the same general source, viz. terrestrial effluvia, and which +prevails in the East and West Indies, and on the coast of Africa. + +When and where intermittent fever only is produced, it would appear that +the effluvia from the soil are less virulent and concentrated, and +perhaps their activity is modified or tempered by a proportionately +great quantity of watery vapour combined with them in the atmosphere, by +the climate of the country, and by the constitution of the people. + +In this country, even so lately as half a century ago, ague or +intermittent fever prevailed to a considerable extent, but is now almost +unknown. + +In East Lothian many of the old inhabitants remember ague as being a +common disease in that county. At present it is there unknown. + +In respect to this disease particularly, the health of the population of +England has greatly improved, and it is well ascertained that the +gratifying fact is chiefly owing to the country having been cleared of +its superabundant wood, which prevented the land being readily dried, +and which interfered with the due action of the winds, and to the speedy +removal of water from the surface of the earth by draining, which is now +so universally adopted. By draining, the water which formerly formed a +receptacle for the decomposition of animal and vegetable remains, is now +carried off, and with it the opportunity it afforded for the extrication +of unwholesome vapours. + + + + + CHAPTER IX. + OTHER CASES OF PESTILENCE—FAMINE—UNWHOLESOME FOOD AND DRINK. + + +The operation of vitiated air in the production of disease is often very +much assisted by the presence of other prejudicial influences. + +It has been frequently remarked that one stroke of misfortune seldom +comes alone, and that observation holds with striking force in reference +to the causes of disease. One cause of disease produces another, which +in its turn generates another, and so on, till the tendencies to, and +the excitants of, pestilence, are so strong and so numerous, that whole +communities are affected, one after another. + +It not unfrequently happens that the predisposing source of some of the +most severe visitations of the most virulent distempers, is the want of +food, which generally depends on the exorbitant prices of provisions, +raised either by the arbitrary regulations of rulers, or by comparative +scarcity. + +The total or almost total want of food is calculated to bring about, +very shortly, a mortal result, from exhaustion or from sinking of the +powers of the system. + +When food is not withheld altogether, but is only given in sparing +quantity, in an amount insufficient for the maintenance of the body in +vigour, a condition of the system is induced, in which the functions are +imperfectly performed, in which the blood and the various humours become +universally prone to morbid change, and in which there arises a great +tendency to disease of a low or asthenic character. + +If, under such privation, vitiated air be present, whether arising from +men in health, but uncleanly or crowded in close apartments; from the +clothes, or excretions of the sick; or from terrestrial effluvia; it +will give form to disease, will act as a spark amid fuel, and will +shortly convert any predisposition to sickness that may exist into +reality itself. + +In those suffering under scarcity of food, there is generally +experienced great depression of mind, which is hurtful in itself and +injurious by preventing sufficient exertions for the maintenance of +cleanliness: there is an inability to procure requisites for the +purpose, and when, perchance, they are obtained, there is too often too +much apathy or supineness to admit of their being used. + +That miserable individual who is famishing, who is so unfortunate as to +hear his helpless children call for bread, which he, alas, cannot give, +who himself is exhausted and sinking with want, is seldom found to be +very solicitous about cleanliness. + +A mother so situated will, in her misery, amid her actual sufferings, +and with the dark yet immediate prospect of further hardships, forget +the necessity or disregard its call; of removing impurities from her +hut, of retaining the persons and clothes of her family clean—and of +washing the furniture, the walls and floor of her pestilence-haunted +cabin. + +In such a situation, cleanliness is neglected and impurities of all +kinds accumulate which emit effluvia, to add to the number of the causes +of gradual death impending over a family thus situated. + +Let a case be supposed in which disease makes its appearance in +obedience to the summons of so many forces, and let the malady be of a +low or putrid character, and the patient dangerously ill. This family is +unable from depression of mind, and from that exhaustion attendant upon +actual want, to give him the requisite attention and assistance, and +neither the means of cure are administered, nor is a suitable diet +afforded. Effluvia arise, and no means being adopted to remove them, +they become highly concentrated, and prove the immediate exciting cause +of disease among all around who may be prepared by the operation of +other favouring influences for that consummation. The occurrence of +typhus fever among the labouring classes of this country, which is +observed every winter, but more especially on those occasions when +provisions, the necessaries of life, are high in price, when employment +is with difficulty obtained, and when the wages are low, sufficiently +attests the fact that scanty food is a powerful cause of disease, and +one of a widely extended range of action. It is invariably in those +years when there is least correspondence between the severity or +inclemency of the season, the price of provisions and the means of the +labourer that typhus fever commits most havoc. I have had occasion to +note the prevalence of an unusual amount of disease, and amongst other +forms, that of fever, in winters following partial failures of the +crops, and the most satisfactory evidence has been afforded that a large +proportion of the sickness was the consequence of high prices, and +consequent scanty and insufficient food. + +Such great prevalence of disease can be readily accounted for, when it +is known that the ordinary amount of the wage of the day labourer does +not exceed nine or ten shillings per week. I have heard labourers of the +most sober and frugal habits affirm, that if their whole wage were spent +in the purchase of oat meal for porridge, and of bread, that there would +not be more of those provisions than would barely satisfy their children +and themselves. + +A scanty and unwholesome diet induces a bad and acrimonious state of the +fluids, and leads to many diseases, and among others, to scurvy, which +was long a frightful pestilence among our sailors. + +Where there exists that tendency to scrophula, which is common in this +climate, the relaxing influence of a poor and scanty diet is +particularly hurtful, and proves the exciting cause of that hideous +disease in all its frightful forms. Scrophula is much connected with a +sluggish state of certain organs called glands. These organs are found +in all parts of the body, and in health vary in size from that of a +pin’s head to that of a bean, but in scrophulous subjects they are found +much larger, the smaller being often more than the size of a pea, and +the larger being equal to a hen’s egg. + +Glands are congeries of vessels in which fluids of various kinds are +elaborated, and it is partly from these fluids or those from which they +are formed, stagnating in their vessels, owing to want of vital action, +that the swelling arises, which is always found in scrofulous subjects. + +That sluggish disposition of these parts is generally connected with a +languid and lax state of the general system, which is liable to be +greatly increased by whatever diminishes the vigour of the body. Few +circumstances are better calculated to produce that effect than +insufficient food, and hence it is that those diseases whose foundation +is a scrophulous taint, are so much promoted in times of scarcity, and +among individuals accustomed to a liberal diet when accidentally placed +on scanty fare. + +Instances are known where persons have become affected with weak eyes, +with tenderness, watering and disposition to ulceration in these organs, +immediately upon being put on spare and poor diet, and where a liberal +supply of nutritious food has proved an almost immediate cure. That +affection of the eyes was a form of scrophula, and fortunate it was for +them that the form in which that disease manifested itself was not more +dangerous. They had much reason to be thankful that the injury was +capable of cure, and was not irremediable, as it has been in many +instances, where the first intimation of the bad consequences of a +scanty and insufficient diet has been decided and incurable consumption +of the lungs. + +When the glands which assume the scrofulous action are those of the +lungs, and when they become the seat of the formation of matter, +pulmonary consumption is said to be produced, a disease which annually +carries off a great proportion of the adult population of this country. + +Consumption of the lungs, or pulmonary consumption, is a common +affection among those who subsist on scanty and insufficient food, and +is frequently observed with dogs and other animals whose sustenance is +small and precarious. Scrophula manifests itself in other forms, not +less severe and extremely loathsome—in running sores on the neck and +other parts, in swellings of the joints, and in various wasting diseases +of the bones and their coverings. + +In the various forms which this disease assumes, the blood and the +different humours of the body become unhealthy and often acrimonious. +The milk of nurses who are tainted with that habit is unwholesome, and +when they are made to subsist on scanty and insufficient diet, it +becomes poor, less nutritious, and positively injurious—and instead of +being bland and white, it often appears watery and yellowish, and is +irritating and acrimonious. + +Food of an unwholesome or vitiated quality is also injurious, and has on +many occasions proved to be the cause of much disease. Plants as well as +animals are subject to disease, and food when obtained from such sources +is highly unwholesome and detrimental to health. + +The flesh of animals which have laboured under disease, has, on many +occasions, done much harm, and is liable to be much more injurious than +flesh which is merely putrid from being too long kept. Flesh merely +putrid much more seldom proves hurtful, as, long before it can be very +pernicious, it becomes so offensive that it cannot be consumed. +Moreover, food which has acquired a slight taint, is more easily +digested, its fibres become less tense, less hard, and more easily +divided and dissolved in the stomach. + +But the most important injuries of the kind have arisen from the use of +diseased grain. On the Continent the rye sometimes becomes diseased, and +the grain throws out a fungus somewhat like the spur of a cock. Rye thus +deteriorated, when used for food, has produced disease of a very serious +character. Persons who partake of it suffer great pain of stomach, fiery +heat in the extremities, and very violent convulsions. This spurred rye +produces mortification of the extremities, of a very remarkable nature. + +The late celebrated surgeon, Mr Pott, thus describes these affections. +“At the extremity of one or more of the small toes, in more or less +time, it passes on to the foot or ankle, and sometimes to a part of the +leg, and in spite of all the aid of physic and surgery, most commonly +destroys the patient. It is very unlike to the mortification from +inflammation, or to that from external cold. In its severer attacks, +however, the constitution seems to be generally contaminated, the mind +and body become equally debilitated, there is great irritability and a +tendency to convulsive action.” + +Rye thus diseased produces another distemper, which partakes of the +nature of typhus fever and that of plague: it is called by the French +“Mal des ardens,” and is generally considered one of the worst forms of +the pest. That disease is marked by the most virulent character, and +has, on many occasions, committed the most fearful ravages. It commences +with a sensation of burning, prostration of strength, delirium, and +vehement headach; a bad form of erysipelas attacks the skin, ending in +suppuration, matter forms in the armpits and groins, and these symptoms +almost invariably terminate in death. There is good reason to believe +that the fungus or cock-spur is the product of disease in the plant. It +is about the size of a cock-spur, is coffee-coloured, and may be readily +detected when the farmer is disposed to use his eyes. + +In this country, wheat which has been blighted or infected with the +parasitic plant called mildew; has sometimes produced very bad effects, +not unlike the severe burning at stomach, and the mortification which +supervene on the use of spurred rye on the Continent. Not long ago, +several families living in England were nearly destroyed by their using +some diseased grain, which a farmer, knowing it to be bad, had sold at a +reduced price. Other plants are sometimes known to be attacked with +disease, and in that state are ascertained to inflict much mischief. The +potato is more particularly injurious when its quality is bad. + +Plants, like animals, may be affected with disease, and may be most +unwholesome, without exhibiting any very marked signs of their morbid +condition. + + + DRINK. + +Drink is as essential as food itself, to the maintenance of the health +of man. Thirst is no less urgent than hunger itself, and it often +happens that it must be satisfied when the calls of the appetite for +food are unheard. Drink of a wholesome quality is highly salubrious, and +conduces much to maintain the blood, and the various humours in a +healthy condition. Water is the only beverage with which Providence has +directly supplied his creatures, and is, under ordinary circumstances, +the liquid of all others the best adapted to their use. + +Pure water is refreshing, cooling, and dilutes the blood, which, without +some diluent, would become too thick to move readily along its +containing vessels, to perform aright its manifold duties, and to +accomplish its numerous purposes in the animal economy. Water taken into +the stomach goes to supply that very considerable part of the mass of +blood which is constantly earned off in the shape of sensible and +insensible perspiration, and of other secretions, and to correct the +tendency in that vital fluid, to become irritating and acrimonious from +the formation and accumulation of various salts. + +In order that the deleterious action of some liquids may be the more +readily understood, we will inquire how drink, which is taken into the +stomach, is there disposed of. + +One of the chief objects which is obtained from the use of drink, is the +dilution and mollifying of the blood; and in order that this important +purpose may be effected, it is necessary that they be brought in contact +and mixed with each other. + +Water, or any watery beverage, being received into the stomach, many +thousand vessels open their mouths upon the walls of that organ, and +imbibe the contained liquid, in virtue of a vital action which they +possess. The liquid is soon sucked up, and is carried by the veins and +the absorbent vessels into the general circulation, there to be mixed +and incorporated with the mass of blood. It has been popularly thought, +that there exists a direct communication between the stomach and the +kidneys, by which the contents of the former are conveyed to the latter +organs; and that supposition probably arose from the fact, that the +kidneys have an immediate increase of duty after copious drinking; and +that fluids having a peculiar and strong odour have been detected, +discharged, very soon after their reception into the stomach. + +However, there is no direct communication between these organs, and all +liquids which are taken into the stomach must be passed through the +general circulation before they can reach the kidneys; and thus it is +worthy to be observed, that liquids which are possessed of deleterious +properties, have an ample field for their operation. + +It is rare that any bad effects follow the use of moderately cold water +in a state of purity, and any instances in which injury has followed, +may, with perfect propriety, be regarded as depending on accidental +circumstances. + +It sometimes happens, that water free of impurities, cannot be obtained, +and that, what is highly impure is taken into the stomach. Many nations +are occasionally subject to the privation of pure water, and are +compelled to have recourse to the tainted waters of sluggish rivers, of +almost stagnant rivulets, and putrefying lakes; and the consequence is, +that their health suffers, and that the invasion of disease is much +promoted. + +The inhabitants of Switzerland, and of several other countries, are +supplied on some occasions, with no other water than that which is +obtained from snow, and the prevalence of goitre among the Swiss, has +been attributed by some physicians to that circumstance. + +But man is not satisfied with this excellent beverage—water—which is +ever at hand, and to be obtained without a price. + +While yet little advanced in the knowledge of the arts, man discovered +that the various juices with which the various fruits of the earth +abound, afforded, during fermentation, a liquor which possessed +properties such as strongly recommended it to his use. These juices, +after fermentation, prove exhilarating and intoxicating, and all the +nations of the world have their respective wines or intoxicating +beverages. This liquor, which is the product of fermentation, gives to +these juices their peculiar character. It is called spirits of wine, is +colourless, and is lighter than water. + +The liquors in which that active agent resides, when taken in small +quantities, quicken the circulation of the blood, render more acute the +perceptions, and augment the heat of the body. When these liquors are +taken more copiously, the circulation becomes violently affected, the +face flushes, and the blood is sent to the head, with too great +velocity, and in too great abundance. + +At first the mind is stimulated, but there gradually ensue sleep, +stupor, and privation of sense and motion, which may continue even unto +death. Several cases, in which death took place in this way from +drinking to excess, are detailed in Mr Watson’s excellent work on +homicide. But when the quantity which is taken is insufficient to +produce the last-mentioned effects, but is often repeated, it frequently +happens that disease, more or less acute, attacks some of the more +important organs of the body, as the stomach, liver, kidneys, brain, +heart, and the general nervous system. + +The diseases which follow the long continued excessive use of liquors, +containing spirits of wine, vary in their nature, but, on the whole, +they prove highly dangerous, interfere with the performance of some of +the most important functions, and often lead directly to a mortal +result. + +Where death is not the immediate consequence of the diseased condition +of these organs, symptoms arise which make the course of life run +bitterly along, the general system breaks up, the miserable victim +presents in vivid colours, the signs of premature decay, the accession +of acute and mortal sickness is greatly favoured, and the intellectual +faculties are impaired. + +Many melancholy instances are known of soldiers at the sacking of +conquered towns, who, indulging in wine and other spirituous liquors to +great excess, have died in vast numbers, both immediately, and more +slowly, through the operation of disease, which had been induced by too +deep potations, by too long protracted carousing, and by that exposure +to those influences favourable to the developement of disease, to which +excess never fails to lead. + +“Some thousands of soldiers covered the great square and the adjoining +streets (of Moscow), but they lay extended and stiff in front of the +magazines of brandy which they had broken open, and from which they had +drawn death, expecting to derive from them life.”[8] + +Footnote 8: + + Segur’s Expedition to Russia. + +The habit of indulging to excess in spirituous liquors, when it does not +directly induce pestilence, assuredly lays those who are its victims, +particularly open to its invasion, and is, therefore, entitled to be +regarded as a very important agent in the great tragedy of life which is +enacting. + + + + + CHAPTER X. + CAUSES OF PESTILENCE CONTINUED—COLD, WANT OF CLOTHING, AND + SHELTER—DEPRESSION OF MIND—INFLUENCE OF WEATHER, CLIMATE, HABITS, &C. + + +Few of the primary causes of pestilence among large bodies of men are so +powerful or so extended in the range of their action, as extreme and +long continued cold, want of sufficient clothing and shelter, and +depression of the mind. + +Coincident with many of the epidemics which are wont to prevail in this +country, these circumstances are almost, without exception, found to be +present; and if they are not admitted to be considered as the sole and +exclusive causes of the prevalent disease, it is proved that they are +co-agents or adjuvants of the very first importance. + +Much of the continued fever which infests the poorer classes of our +countrymen, and almost all the pleurisies, colds, and consequent +consumptions, which prevail more or less among the various ranks every +winter, are in a very great degree dependent on the extreme cold of the +season which suddenly sets in, and against which the dress of the +inhabitants of these islands is insufficient to provide. The labouring +classes suffer much, more particularly from the action of cold and the +inclemency of the weather. They are generally very scantily clothed, +nay, they are sometimes scarcely covered, and the consequence is, that +the cold makes a strong and lasting impression, the circulation on the +surface is suddenly impeded, the perspiration is checked, and the whole +fabric involuntarily shivers. Now these are the very first symptoms of +fever, and unless the constitution is possessed of stamina to remove +those symptoms without loss of time, and to establish the circulation in +its vigour again upon the surface of the body, that disease, or some +other, will undoubtedly be established. + +When a body thus affected with cold is placed in a warm situation, there +supervenes an excitement or reaction, which is marked by increased force +of the circulation, and with redness and heat of the skin, a condition +which is often experienced by persons who go immediately to the fire +when newly arrived from a journey in the cold. When that reaction +ceases, and is followed by a sense of coldness and by shivering, which +again is succeeded by reaction, fever, in its proper sense, is +established, and will assume a character of violence, lowness, or +malignity, according to circumstances. + +The clothes, the house, and the diet of the working man, are +insufficient to protect him against the action of the cold, and to +resist its operation when once it has fastened upon him; and thus it is, +that to comparative want and to many privations, there is so often +conjoined so much disease. + +But it is in vain to expect any other result as long as our most +deserving labouring population is worked in an inordinate degree,—so +long as they labour beyond what their limited energies will, with +impunity, permit—so long as they are often unable to obtain a diet +sufficient for the maintenance, even of an idle person, and so long as +their very breasts, from very want of clothing, are literally open and +exposed to the fiercest blast that blows, and to the most searching and +chilling rain that falls from Heaven. + +Observe the industrious labourer at his work; behold his powers are +taxed to the utmost, his energies, his capabilities, are put upon the +stretch, and the entire fabric, God’s most complicated and most delicate +creation, is actually labouring and heaving with protracted exertion. +His blood distils the dew of labour, and his clothes, such as they are, +are moistened with perspiration bursting from a thousand pores. + +It frequently happens, that the labour of the poor man being over, +sorely fatigued, too exhausted even to enjoy the consciousness that his +hour of rest has arrived, with a heavy and unwieldy gait and hanging +head, he seeks his comfortless abode, his scanty board, his dreary, +dark, scarcely furnished apartment, with its faint and glimmering +embers. + +He swallows his spare repast and falls asleep at his fireside, but +having no change of clothes, and those which he has on being wet with +perspiration or with rain, are allowed to dry upon him. In the mean time +the heat of the fire proves sufficient to create a steam on the side +next it, and the house of course being open to the wind, currents of +air, chillingly cold, pervade the apartment, and strike upon that side +of the poor inmate which is most remote from the fire, and thus he of a +thousand misfortunes and privations is actually steamed on one side, and +perished with cold on the other. Persons placed in such a situation can +scarcely, for any length of time, escape disease, and it is consonant +with my knowledge to say, that the condition of a great proportion of +the labouring classes is not one tittle better. Fever and many other +diseases will continue to assail our labouring population as long as +their food is insufficient, as long as they are barely covered during +the inclement season, and as long as their habitations scarcely own a +roof or a door, as long as the wind and rain enter at a thousand +crevices; and while the cheerful and salubrious light of heaven is +denied admittance by the old hats, bunches of straw, and rubbish which +so frequently, in the absence of glass, fill up the space originally +intended for a window. Yes, so long as every energy is exerted, and +every moment that can be cheated from rest, to obtain that wherewith a +supply of the necessaries of life may be procured, and when every other +consideration sinks and gives way to the more pressing wants of nature, +will disease prevail. + +Such is the destitution among many of the labouring class, and the vast +amount of disease which prevails among them, is the necessary +consequence. + +The following facts illustrate well the influence which scanty food, +insufficient clothing, and the privations attendant upon poverty, exert +in the production of disease. + +During the last three months (10th February 1839), the fishermen and +potters living in Prestonpans, have been in a very destitute condition, +the former, partly from the very boisterous weather which has prevented +their going regularly to sea, and the latter from the closure of the +potteries at which they were employed. During that time, these two +classes of people have been suffering much from fever, about ten of +their number having died in that short period; while the people, +amounting to 750, including children, connected with Prestongrange +colliery, who are well employed, well paid, and well fed, though +inhabiting the same locality, and the houses stretching from Prestonpans +to Musselburgh Links, have been almost entirely free of that disease, +fever having affected two of those families only, in the course of the +same time; and while fever is still prevailing extensively among the +potters and fishermen, the people connected with the colliery have been +entirely free of that disease since about the 7th of last December. On +these facts I am well informed, being the medical attendant of the +colliery. + +Let us mark the operation of the same or similar circumstances upon +soldiers; the consequences of exposure to cold, to the inclemency of the +weather, of the want of sufficient clothing, and of habitations, among +young and robust men, employed in the most active and spirit stirring +occupations, connected with the most kindling and heart-rousing +anticipations, and flushed with the glory and honour of victory. + +Let the case be that of Napoleon’s Grand Army in Russia, perhaps the +most remarkable recorded in human history, and that, perhaps, will equal +any that will yet mark the future career of man, in the total +discomfiture, in the unspeakable sufferings, in the awful destruction of +human life, and, in short, in the triumph of nature over humanity, +which, from beginning to end, attended the disastrous retreat of that +mighty congregation of France’s bravest sons. + +Let the case be that of the retreat of the Grand Army from Moscow, +which, alas, was one horrid series of unprecedented disasters, of wreck +upon wreck, whose course was one prolonged deathbed—one white, one +snow-white shroud—one extended grave, which barely spared enough to +convey the fatal tidings, and which received heroes by thousands, valour +and all that is ennobling in the mass, which monuments can never +note,—and broken hearts and broken ties, those of husband, of father, +and of comrade, for which tears have flowed, but which tears can never +bind again. + +“At every step he (the Emperor) saw his soldiers, stricken by cold, +extenuated by hunger and fatigue, falling half dead into the hands of +the Russian cavalry. + +“Around these (their bivouacs) hunger and cold rivetted those wretched +sufferers. It was impossible to tear them away. + +“Above sixty thousand men well clothed, well fed, and completely armed, +attacked eighteen thousand half naked, ill armed, famished men, +encumbered by more than fifty thousand stragglers, sick and wounded. For +two days the cold and misery were so intense that the old guard lost a +third, and the young guard one-half of their effective men. + +“It was indeed but the shade of an army, but it was the shade of a grand +army. It felt itself conquered by nature alone. + +“Under these circumstances, the elements appeared more hostile to us +than the Russians themselves. Their climate did its part—if they had +done theirs.” + +In that disastrous retreat there was a most extraordinary accumulation +of influences powerfully destructive of health. There was extreme cold, +that of an intensely cold climate, there was an insufficiency of food +and of clothing, and there was a want of proper habitations,—the +wretched sufferers lying almost naked around their fires in the open +air, perhaps enjoying the partial protection of a shed, a ruin, or a +stable, and sometimes seeking shelter in the carcasses of horses. But +there was also present another influence, highly prejudicial to health, +and equal of itself to a considerable proportion of the fearful amount +of disease which prevailed, and that was depression of mind. + +Depression of mind conveyed a withering influence to the hearts of the +bold victors of a thousand actions, and paralyzed the whole energies of +the system. Here it acted on a gigantic scale, and its work of death, +yes, of death itself, was not less prodigious. + +The humiliation, the mortifications, and the heart-rending misfortunes +of which these once victorious but now unhappy men were the prey, could +not but induce a state of mind, which, of all other circumstances, must +have been the most favourable to the invasion of disease. Daily +experience demonstrates that disease is much favoured by the presence of +circumstances, such as are referred to in the following passages. + +“That grand army, which, in the course of the preceding twenty years, +had marched in triumph through all the capitals of Europe, now, for the +first time, reappeared, mutilated, disarmed, and fugitive in one of +those (Konigsberg) which its glory had reduced to the greatest +abasement. Its inhabitants hastened into the streets, as we passed +along, to observe and reckon our wounds, and to estimate by the number +and the extent of our misfortunes, the foundation on which they might +build their hopes: we were forced to regale their eager and delightful +eyes with our miseries; to submit to pass under the yoke of their +delight, and, dragging our squalid and miserable forms in full review +before their detested scrutiny, to march under the almost insupportable +weight of calamity which the hatred of the spectators beheld even with +transport.”[9] + +Footnote 9: + + Segur’s Expedition to Russia. + +The very knowledge and observation of mental distress and bodily +suffering creates a depression of mind, and sickness arising therefrom +spreads among the spectators, although, in other respects, they are +comfortably situated, and have abundance of clothing and wholesome food. + +Segur further relates:—“Consternation took possession of the soldiers of +Marshal Victor, though unbroken in numbers and in spirits, after having +given way to their customary acclamations on beholding their Imperial +commander, when, instead of the grand column which was to achieve the +conquest of Moscow, they perceived behind Napoleon, only a band of +spectres, covered with rags, women’s pelisses, bits of carpet, or with +dirty cloaks scorched and burnt by the fire of the bivouacs, and with +feet wrapped in the most wretched tatters.” + +Depression of mind favours the accession of many diseases. This was +noticed when the prevalence of fever was under observation. + +It has been remarked by Citois, that the colic of Devonshire and Poutou +attacks more particularly those families who are suffering under that +calamity. + +Disease frequently makes its first appearance when friends and relatives +assemble to pay the last marks of respect at the funeral of the +departed. I am acquainted with several instances in which, shivering, +tremors, and sense of great debility, have suddenly supervened in men in +perfect health upon the “lifting” of the corpse, and upon the “lowering” +into the grave, moments in which the hearts of many would seem to +threaten to melt away, and in which they have proved to be the primary +symptoms of fever; the other more violent and more dangerous +characteristics being duly developed. A man, named Stevenson, died at +Tranent last winter; the friends were assembled in the house to attend +the funeral; his brother arrived from a distance, just as the body was +about to be lifted, went into the apartment, apprehended he smelt +infection, and instantly felt very ill. After having gone to the +churchyard, and returned home, he was immediately attacked with +sickness, which assumed the form of fever, and he died in the course of +a few days. + +The following statement, made by Dr Paris, illustrates well, how +depression of mind, by affecting the system, promotes the action of +poison:— + +“A patient had been taking mercurial medicine, and using frictions for a +considerable period, without any apparent effect; under these +circumstances, he was abruptly told that he would fall a victim to his +disease; the unhappy man experienced an unusual shock at this opinion, +and in a few hours became violently salivated (that is, became affected +with the peculiar action of mercury on the mouth).” + + + CLIMATE. + +Besides the various causes of pestilence to which reference has been +made, there are many others connected with peculiarities of climate, +irrigation, soil, and habitudes of nations, of which the limits of this +work will not permit an extended account. Of the peculiarities of +climate, the most important are the greater or less intensity of the +sun’s rays. It is found that much solar heat disposes to excessive +action of the liver, and hence it is that fever in tropical regions is +biliary; characterized by derangement of the biliary organs, of which +the liver is the principal; that fever in the West Indies is yellow, a +colour which proceeds from the dissemination of the bile throughout the +body. Few persons who have remained long within the tropics are free of +disease of the liver, and this is well known to be a common, nay, almost +a universal complaint among soldiers who have returned to this country +after many years’ service in those regions. + +Another active agent in the production of disease in these climates is +the great fall of dew which takes place between the setting and rising +of the sun, and the extreme degree of cold which attends it. The dew +begins to fall as soon as the sun gets below the horizon, and increases +till about an hour or two before dawn; the cold at that time is extreme, +more particularly felt on account of the great heat which is experienced +during the day. The cold is the immediate cause of the falling of the +dew, which is only the water that was dissipated in vapour by the action +of the sun’s rays. The dew favours the action of the cold; and persons +who are exposed to it, are in consequence frequently attacked with +disease. + +Persons unaccustomed to the heat, and ignorant or regardless of the +consequences of exposure to the night air, often suffer much, and become +affected with the peculiar distempers of the climate, in this manner: +they lie down on the ground scantily covered, while the sun is still +above the horizon, and make no provision for the cold and damp of night +which is sure to overtake them. + +Persons go to bed also with too few clothes, being then warm and +oppressed with heat; in the night the dew falls, the cold arrives, and +they are often awakened with severe rigors or shiverings; and thus +fever, dysentery, and the like disorders are induced. + +The winds in all latitudes are often instrumental in the production of +disease. Some have been already referred to in connexion with the +conveyance of vitiated air. Some are hurtful from their excessive heat, +as, for instance, those blowing directly off the burning deserts of +Arabia and of Africa. The Sirocco is not only extremely hot, but is +copiously loaded with aqueous vapour. It visits Italy, blowing there +several days at a time, and acts almost as a vapour bath upon the +inhabitants. The Sirocco blows off the deserts of Africa, passing over +the Mediterranean sea, there imbibing a large quantity of water, +converted into vapour, and rushes upon the fair shores and degenerate +population of Italy. Its immediate effect is to relax the system, and to +open up all the pores on the surface of the body. These effects are very +hurtful to health, and become particularly so, when they are long +continued, as sometimes happens. But more dreadful are the results of +exposure of persons so situated, to the sudden action of an intensely +cold blast, such as the Tramontane, which, driving from the northern +side of the Alps and Pyrenees, passing over their snow-capt summits, and +sharing their bitterness and frost, rushes, without warning, upon the +inhabitants. + +The tramontane is very cold, and acting upon persons in a manner +“forcing” in a hot house, soon produces pleurisies, colds, consumptions, +&c. &c. + +These vicissitudes in Italy, and those which are wont to occur in +regions within the tropics, are much greater than the variations of +weather which are experienced in the British Isles, and which are +comparatively harmless; or are hurtful, at least, in a much less degree. + +In many countries the rivers periodically overflow their banks and cover +the surrounding territory. The Nile overflows annually, and when the +water has almost disappeared by infiltration into the soil, and by +evaporation, and when that which is left is muddy, slimy, and mixed with +organized remains, exhalations arise, and a vitiated atmosphere is +produced, which is said by medical men, who have lived upon the banks of +that river, to be productive of plague. + +The territory again on the banks of the Canton river in China, is almost +constantly under water, and its fertility is thereby much increased. The +ground there is used for the growth of rice which delights in a soil +covered with water. When the heat is intense, when the water contains +organized putrefying materials, and when the weather is close, and the +atmosphere is a little agitated, then vapours ascend which, mixing with +the air, cause it to be vitiated, and to be productive of malignant +remittent fever. + +The habits of nations are also influential in the production of disease. +The privations and penances which devotees endure are followed by a very +hurtful influence on the health, whether they be what are enjoined, or +whether they be voluntarily suffered, as they suppose, to conciliate the +favour of the Deity. + +The diet, clothing, occupations, pleasures, government, laws, social +usages, genius, and ambition of nations, materially influence their +health, and give tendencies to particular maladies; but interesting as +the subject is, the investigation cannot be pursued here. + + + + + CHAPTER XI. + THE AVOIDANCE OF DISEASES MARKED WITH PALPABLE CONTAGIOUS POISONS—THE + LIMITED RANGE OF ACTION OF CONTAGION. + + +It was shewn in the first part of this work, that the contagious poisons +of disease, such as the matter of small-pox, are known to act in two +modes only, _first_, by application of the palpable matter itself to a +person, or by contactual contagion; _secondly_, by application of +clothes or other such substances, impregnated with that matter, forming +what has been styled fomitic or mediate contagion. It was also shewn, +that their action through the medium of the atmosphere, has never been +ascertained. Experiments were detailed, which were performed on those +poisons, to ascertain their capability to become dissolved in the air, +and their evidence was as strong as it possibly could be, against their +possessing that attribute. + +It was, in short, fully ascertained, that contagious diseases do not +propagate by atmospheric contagion. + +Contagious diseases propagate among those who expose their persons to +contact with the matters or clothes impregnated with them. There are +many facts of an incontrovertible character, which prove the occasional +operation of the former mode at least, and to render probable, that of +the latter; and hence, whatever attention is paid to cleanliness of the +sick person, his apartment, and to the prevention and removal of +vitiated air, persons touching a body, when there is present on its +surface specific contagious poison, such as the matter of small-pox, or +even handling clothes, which have become impregnated with it, incur a +risk of being affected with the same disease, by means of that matter or +fomitic contagion. + +In all the contagious diseases (those in which there is eliminated a +palpable poison, or matter capable of causing the same disease in +others), their respective matters are invariably formed, and are apt to +propagate in the modes specified, so that visitors and other attendants +should ever be upon their guard, the first not to touch the sick person +at all, and the latter not to touch more than is necessary, and to take +precaution to render the risk as slight as possible. + +Subjoined is a list of diseases which are known to be contagious, or to +be possessed of a matter of the nature referred to, and that are +therefore wont to be propagated by contact with the sick, or with his +clothes. + + Small-Pox. + Scarlet Fever. + Measles. + Chicken-Pox. + Cow-Pox. + Itch. + Plague. + Porrigo. + &c. + +These are almost the only diseases known in this country, which are +positively ascertained to be characterized by the elimination of +contagious matter, and which, therefore, there is any risk of getting by +contagion. The continued fever of this country has been supposed, by +some physicians, to be a contagious disease, from there being sometimes +observed pimples on persons affected with it; but that is by no means an +ascertained point. + +Those above enumerated seem to include all the most important diseases +in this country, which are capable of being propagated by contagion, +acting in either of the two ways already described. Some of them are +capable of affecting the same individual only once, and some affect +persons as often as they are exposed to their specific contagious +matters. + +How comparatively small, then, is the range of contagion,—an agent which +has been thought to accomplish worlds of mischief, and to destroy almost +whole communities. + +Visitors may approach within a very short distance of persons afflicted +with these distempers, without danger of suffering, provided they do not +touch the bodies or the clothes. + +They have nothing to apprehend from the atmosphere, if attention is paid +to the maintenance of its purity,—such as is necessary in other +situations, as well as in the sick-room. + +Never brought into that immediate contact with the poisons which is +necessary for their propagation, they stand in need of no directions for +their removal or counteraction. + +Those persons, on the other hand, who are called upon to touch the +patient and his clothes, are exposed to danger; and they should lessen +its amount, by instantly putting their hands into warm water, and by +freely washing them, with the assistance of soap,—and that ablution +should be performed after each instance of contact. + +I have often had occasion to feel the pulse of persons ill of the worst +forms of confluent and black small-pox, and any risk that has thereby +been incurred, has been removed or remedied by immediately washing the +hand as directed. + +In addition to washing, after that process is done, a small quantity of +a strong smelling liquid, such as Lavender water or Eau de Cologne, +should be poured into the hands. Their grateful odour may hide or cover +that of the apartment, which the attendant may mistake for contagious +air, as is often done, and thereby remove groundless apprehension. These +seem to be the chief precautions that are necessary for meeting the +dangers of contagion, if there is included what is sometimes used, viz. +a covering for the hand,—a glove and the like,—which, as being harmless, +and such as may possibly be useful, should be employed; and likewise the +avoiding of eating and drinking with the same instruments and vessels +used by the sick persons. + +The propagation of disease by contagion, in the modes already stated, +though it can take place, and though it sometimes does take place, still +there are the strongest grounds for supposing it a comparatively rare +occurrence. + +I have already shewn, at the beginning of this work, that in one form, +the atmospheric, contagion never operates, and I am now prepared to +assert, that in the two forms in which alone it can act, that the +instances of its undoubted agency are by no means nearly so common as +they are commonly believed to be, especially in connexion with those +acute diseases, accompanied with fever. + +It is my belief, founded on much observation, study, and reflection, +that almost all cases of those contagious diseases, arise from causes or +circumstances connected with those great agencies already detailed at +full length, as inductive of pestilence in general, and of a nature +epidemic, endemial, meteorological, and the like. + +I am led to the opinion, that this course of origin, even in contagious +diseases, is the rule, and that the origin of disease, by contagion, +whether contactual or mediate, is the exception. The grounds of this +opinion are,— + +_1st_, A fact well ascertained, and of which I had lately two instances, +in houses contiguous. Infants neither inoculated, nor vaccinated, lie +with their mothers and others ill of small-pox, and do not take that +distemper. + +_2d_, Women, while labouring under small-pox, occasionally bear children +in perfect health. + +The above are common occurrences, and I am in possession of the +particulars of several which came under my own observation in the +beginning of 1838. + +These cases prove the occasional, nay, the frequent inactivity of +contagious poison, even when applied in a palpable form, and in a recent +condition, to the bodies even of those who are not protected against its +operation by inoculation for cow or small-pox, or by a previous attack +of disease; and this inactivity is observed too, when the most ample +opportunity is afforded for the action of the poison, viz. while +children are asleep together in the same bed, and when infants are upon +the breast of mothers affected with small-pox. + +Those very children who thus escape taking disease by contagion, are +frequently known to be seized with that identical disease, at some +future time, varying from months to years, when no other case is known +to exist in the neighbourhood, and where there is no room to suspect the +operation of contagion. + +It is, I believe, as common as the contrary course, for small-pox, and +other reputed contagious diseases, after appearing in one house in a +town or hamlet, to break out in others at a distance and in different +directions, and not to progress from that which was first attacked to +those lying adjacent, or to spread around as from a centre. + +For example, the first case of Typhus Fever which occurred in my +practice, in January 1839, was at Meadow Mill, a village half a mile +north of Tranent; the second case was at a hamlet called Redcoll, about +four miles east; the fourth and fifth cases occurred in Tranent; while +the sixth and last for that month appeared at Elphinstone, a village +situated about two miles to the south-west of Tranent. + +I am led also to the opinion, that the ordinary cases, even of those +diseases which are known to be occasionally propagated by contagious +poison, do not arise from contagion, but from other circumstances and +agencies; by the history of the plague, for while that scourge is +ravaging in the East, and destroying hundreds daily, it frequently +ceases, immediately upon the overflowing of the Nile, which buries and +covers the pestiferous soil, and the putrefying materials which had been +exhaling noxious emanations. + +This sudden departure or cessation of plague, upon the overflowing of +the Nile, proves that contagion, though it may be the cause of some +cases of that disease, is not the occasion of the vast majority,—the +great mass of cases, in short, which constitute the Epidemic; and goes +far to prove that distemper to be dependent upon an unwholesome +condition of the soil, or vitiated atmosphere, and other widely extended +and unwholesome agencies, of a nature totally different from specific +contagious poison. + +That fact goes to prove, in reference to one disease, viz. Plague, what +I believe holds with all other contagious distempers, that contagion, at +most, is only an occasional, while such influences as those to which +reference has been made, are the constant and general causes of +sickness. + + + + + CHAPTER XII. + THE PREVENTION AND CORRECTION OF VITIATED AIR. + + +The important part which vitiated air enacts in the production of many +forms of disease, has been already fully shewn; and it must be admitted, +that whatever has for its objects the prevention and correction of that +principle, is deserving of attention. + +By preventing the production, and by removing vitiated air when already +formed, a vast amount of disease may be arrested, and much of that +benefit will actually be accomplished, which it was boldly but +fallaciously pronounced would revert from many absurd measures which +were adopted, and which are still recommended for the avoidance of +contagion, and would realize almost all the advantages which Quarantine +Regulations, and the most efficient systems of Contagion Police can or +propose to afford; and that, too, at no inconvenience to individuals, no +restraint upon communication, after certain processes of purification +have been undergone, and no ruinous hindrance of commercial +transactions. + +The various sources of vitiated air have been already noted. Some of +them are beyond any present remedy, as the unwholesome condition of the +surface of the earth in many regions, within the tropics, for whose +correction or improvement, time, capital, enterprise, labour, and +perhaps new climates, are essential. To that source of vitiated air, +draining, cutting down superabundant wood, embanking rivers, reclaiming +partially inundated land, and cultivation, must be applied before the +emanations which infest these situations can be prevented from arising. + +Another source of vitiated air is, men being crowded together in close +and confined apartments, where no attention is paid to the preservation +of cleanliness and the removal of impurities, as in some jails and other +places for the confinement of criminals. + +That source of vitiated air is particularly worthy of notice here, +because a very common form of disease which it induces is what is well +known as Jail or Contagious Fever. + +The means for the prevention of this form of vitiated air are obvious. +Large, airy, well ventilated and lofty apartments are essential, if many +persons must be put together; and, where that is not necessary, it is +advisable to have them separated in several different chambers, where +due ventilation is strictly maintained, by retaining the windows more or +less open through the day, or by other equally effective means. + +By the sleeping of many persons in one apartment, the atmosphere is +deprived to a great extent of its more vital fluid, and becomes unfit to +support respiration in its integrity; and the health of the inmates is +not unfrequently injured in consequence. The sleeping of many persons in +one bed-room, therefore, should be avoided, where it is possible; but, +where that is not practicable, it becomes necessary to lessen the evil +consequences, and this may be done by keeping a door or window partially +open during the night, when the weather is not too inclement to forbid +that procedure. + +At all times, exhalations to a great extent are proceeding from the +bodies of men; and, where individuals are much confined to one +apartment, and where that is small, close, and ill ventilated, they +fasten or adhere to the furniture, curtains, carpets, and the very +walls. During sleep, the amount of these exhalations, it would appear, +is increased. It is then that the pores of the entire system, as well +upon the internal as the external surfaces, are most freely laid open, +and that they pour forth their respective fluids most abundantly. The +quantity of watery vapour which issues during sleep from the lungs is +prodigious; and the large quantity of water which is sometimes seen +collected on the panes of windows in the morning, and which is condensed +vapour, affords some idea of the vast quantity of fluid which is exhaled +during sleep. With this watery vapour, other ingredients of a hurtful +nature are conjoined, and, like it, adhere to the furniture and clothes. +When these exhalations are permitted to remain, they impart to the room +a disagreeable odour, cause the bed-clothes to be damp and unwholesome, +which, with the progress of fermentation, at length emit offensive +effluvia. In order to avoid these hurtful consequences, the following +measures should be adopted. When the bed-room is left in the morning, +the window or windows should be opened, and the bed-clothes freely +exposed to the air for some time: the constant passing of fresh air over +the clothes and through the apartment, will shortly carry off the +greater part of the exhalations which may have adhered. + +The window should be left open during a part of the day, if the +atmosphere without is not particularly damp, as the removal of +impurities, when they have adhered to solid bodies, is not effected at +once, or so immediately as is generally believed. + +Exhalations of a very hurtful nature proceed also from excretions, which +should be removed immediately, certainly before fermentation can have +proceeded to any considerable length. + +The furniture of bed-rooms requires special care. The various processes +of rubbing, washing, and scouring, should be frequently repeated; and +articles, such as bed and window curtains, should be oftener in the +washing-tub than is dreamt of by many very careful housekeepers, and +when they are composed of fabrics of a nature to forbid contact with +soap and water, the necessary purification may be effected, at least in +a partial manner, by occasional exposure to the wind in the open air. + +In those apartments in which the sick are contained, the atmosphere is +particularly liable to become vitiated from the exhalations of the body, +and from the excretions being in general more disposed to be virulent +than those of persons in health. + +The necessity for a constant supply of pure air is, if possible, +increased, and the utmost care and attention is demanded, in order that +this may be duly provided. In large hospitals for the reception of sick, +ventilation becomes a point of the most important nature; and, when +efficiently established, is entitled to be considered one of the most +powerful remedies which can be obtained to check the progress of +disease, and to promote recovery, when that is once established. + +Various methods have been devised to promote ventilation in hospitals, +which it is unnecessary to describe here; for this reason, as well as +others, that the importance of ventilation is too well understood by +medical men, for them not to enforce it in establishments of which they +have the management. + +During sickness in private houses, ventilation cannot be too much +enforced. When the weather will permit, one window at least should be +partially opened, pulled down, if possible, during the summer. In +winter, the door of the apartment should be left open for a short time +occasionally; and, if the chamber is not very small, a fire may be used, +which will not only remove the cutting dullness of the air, but will +also ensure a constant change of the atmosphere, from the ventilation +which it causes. + +In some forms of disease, as in the “Sweating Sickness of England,”—the +typhus fever, the skin is wont to become covered with perspiration, +which is particularly prone to undergo putrefaction. To obviate that +putrefaction, and to prevent the formation of effluvia, it is proper to +wash the skin of the patient, in almost every form of disease, with soap +and warm water, which will purify that important organ, and assist in +rectifying its functions. Where the character of the disease is putrid, +sponging the skin with vinegar and water, either warm or cold, should be +adopted, and is often of the greatest use. + +All impurities should be removed from the sick-room, as they are liable +to vitiate the atmosphere; and all clothes and utensils which have been +used by the patient should be immediately put among warm water, and left +there till a convenient season occur for their being thoroughly +cleansed. + +When the patient is in a state to bear the fatigue of being removed for +part of the day to another chamber, advantage should be taken of his +absence from his bed-room, to ventilate the apartment, by throwing open +the doors and windows, to expose his bed and body clothes to the free +action of the air, and to cover the sickly smell frequently present in +sick chambers, by the burning or dissemination of some fragrant +substance in the atmosphere. + + + CORRECTION OF VITIATED AIR. + +The effluvia which are wont to arise in sick-rooms, are sometimes so +very strong, especially where little attention is paid to cleanliness +and ventilation, as to fasten most tenaciously to the contents of the +apartments, and to impart to them a most disagreeable and sickly odour, +not immediately removeable upon the establishment of currents of air +obtained by opening the doors and windows. + +These effluvia, for the most part, are cognizable to the organ of smell, +and they have long been, and are still, vaguely designated “Contagion,” +“Infection,” and the like. + +Where effluvia are not recognised by the organ of smell, there are many +good reasons for believing, notwithstanding that circumstance, that they +may be present in rooms which contain, and which have lately contained, +sick persons. + +Well authenticated cases are on record, where persons in health have +inhabited apartments which, at a former period, contained sick persons, +and have been attacked with disease in such a manner as to leave little +doubt of the presence of unwholesome effluvia, and of their having been +the efficient agency in the production of the evil. These instances have +occurred, where it is impossible to suppose that the effluvia could have +been commingled with the atmosphere during the whole interval, often +amounting to years, from the period of the removal of the sick, to that +of the taking up of their abode there by those who have suffered. + +The period during which the apartment has been uninhabited has, on many +occasions, been too long to admit of the opinion that the atmosphere has +not been again and again changed. It would therefore appear, that not +only the atmosphere becomes infested, on those occasions, with effluvia, +but that the walls, the furniture, and the floors may likewise become +impregnated with them. + +It is consonant with experience to admit, that solid bodies occasionally +combine with, or imbibe, or attract gasiform products, or that aeriform +or vaporic agents adhere to solid substances. + +The opinion may be entertained, that the effluvia of sick rooms may +fasten to the furniture, &c., and in that situation, even where +ventilation is maintained, form centres from whence they may be +disengaged, either constantly, for a long period, or only on occasions +which are particularly favourable for their redissemination in the +atmosphere. + +It is common to designate these effluvia primarily disseminated in the +atmosphere, and the vitiated air which is formed in old fever and plague +wards, and to which reference has just been made, Contagion, without any +other term to mark the distinction between these principles and those +which are legitimately so called. In a previous part of this work, the +distinction has been carefully made, and it was shewn that the effluvia +under discussion do not form, strictly speaking, a contagious, but only +a vitiated atmosphere. + +As it appears that effluvia which arise from the bodies, and the +excretions of the sick, do not only mingle with the atmosphere, but also +adhere to furniture, walls, &c., when concentrated and long exhaled, it +becomes necessary not only to remove that atmosphere in which they are +disseminated, but also to adopt means for the purification of all those +bodies to which they may adhere, in order that the atmosphere may not +become again and again loaded with them, arising, as they may, from the +places to which they are adhering. + +The means best calculated to obtain that end, are those processes to +which reference was made above, viz. rubbing, scouring, washing, and +exposing to the free action of the air. + +But besides these means of purification, there are others, as +fumigations, which are calculated to be highly useful, and which should +be used on all occasions of severe general disease. + +Fumigations are vapours of an elastic nature, permanent and +non-permanent. They are diffused through the atmosphere, and impart to +it their peculiar odours. + +They are highly useful. In the _first_ place, there is reason to believe +that they, especially the more active, may decompose the effluvia which +are mingled with the atmosphere, and which are adhering to solid bodies, +all of which they can be made to reach and act upon, and even to +penetrate where the scrubbing-brush and hot water cannot be applied; in +the _second_ place, they insure a change of atmosphere; and, in the +_third_ place, they effectually cover or hide the smell of the +sick-room, which is at all times highly disagreeable, and which is often +regarded with great terror and apprehension, being ever associated with +ideas of contagion and disease;—and in this way, fumigations are found +of very great value, giving, at the same time confidence to the timid, +and affording something different from what contagion is commonly +thought to be, on which the organ of smell may be safely exercised. + +Some fumigations are produced by the volatilization of solid bodies, as +camphor and carbonate of ammonia, or sal volatile;—some by the +volatilization of liquids, such as vinegar, pyroligneous acid, and the +various essential oils, as cinnamon, rose, thyme, mint, pennyroyal, +carraway, and turpentine, while others are permanently elastic fluids or +gases, as muriatic acid gas, chlorine, and ammonia. + +The first-mentioned substances, viz. camphor and ammonia, are not very +strong, and may be disseminated through the apartment of the patient, +even when he is present, without giving him any uneasiness. Carried +about with those who visit the sick, and who are apprehensive of +contagion, they are useful by affording a grateful odour, which hides +disagreeable taints, and perhaps it is in that way chiefly that they are +useful. + +The liquids which have been named above, have been long used for the +purposes of fumigation, and in general, they may be employed even in the +presence of the patient. A few of them may possibly decompose effluvia, +but there is much reason to think that they are useful, for the most +part, by hiding ungrateful odours, and imparting to the atmosphere, +which is liable to be suspected as unwholesome, a delightful fragrance. + +Vinegar is much used for the purpose, and with very considerable +benefit, and is therefore to be employed. + +The essential oils are capable of being diffused throughout the air, and +with the assistance of heat, are often made available for the purpose of +covering odours. When they are to be used, the oils should be poured +upon a piece of live coal, held in the middle of the apartment; they are +then immediately converted into vapour. In like manner, vinegar and the +other volatile liquids may be disseminated through the atmosphere. + +The oils, the vegetable substances in which they are contained, tar and +the like, are occasionally burnt with the same intention, and sometimes +with advantage. + +The incense so much used by the ancients, was procured for the most part +by the burning of the vegetable substances in which these essential and +fragrant oils resided, by which part of them is diffused in vapour. + +The ostensible and pretended object of the priests, in offering up +incense, while that and other religious rites were performing over the +bodies of deceased persons, was the conciliation and propitiation of the +Deity. But while this was the sole ostensible object of the priests, and +that which was held by the people, as the only and exclusive purpose +proposed, there is good reason to believe that the offering up of +incense, like many other observances of religion, had its temporal, and +worldly, as well as spiritual ends; and that the sweet smelling odours, +which were thought would be so grateful to Heaven, were, on those +occasions, used in no small degree, as so many fumigations, to defend +the pious and resigned priests from the effluvia of the dead body, and +the consequent corruption of the atmosphere. + +The use of fumigations, in a disguised form, was perhaps rendered +necessary, as the purpose of purifying the atmosphere, might have seemed +to cast reflections or imputations on the dead, which the vile, +barbarous, and superstitious people, especially relatives, might have +resented with acts of violence, or which might have thrown priest-craft +into contempt and abhorrence. + +Perhaps it was in reference to this matter, as it was in many others of +graver import, that the ignorant and superstitious condition of the +people on the one hand, and the cunning, subtlety, despotism, and +superior knowledge of the ministers of religion on the other, in early +times, made it convenient that certain ends, thought to be desirable, +should be accomplished without reasons, explanations, or intentions +being given. + +There is, then, reason to believe, that the burning of oils and other +fragrant substances, was used in very early times to purify the +atmosphere from the effluvia of dead bodies. + +The products of the combustion of essential oils, tar, pitch, and the +like, are carbonic acid gas and watery vapour, which, there is reason to +think, cannot be useful in purifying the air, or in neutralizing hurtful +effluvia. + +The permanently elastic gases which are used as fumigations, are the +most potent agents of the kind, and they are generally used, and with +much propriety and advantage, in all cases where disease is of a putrid +character, and where, in short, the atmosphere is likely to be vitiated +to a great extent. They form also the most useful fumigations for the +purpose of purifying the atmosphere, and the walls and furniture of +apartments lately inhabited by the sick, and their employment, in such +cases, should never be neglected, even when there is no great reason to +apprehend vitiation of the atmosphere, for when advantage is doubtful, +there can exist no possibility of detriment. The agent now most commonly +employed, is chlorine gas, and it is perhaps the most efficient in the +list of fumigations. + +Chlorine gas has a greenish colour, and a most disagreeable and +suffocating odour. Water impregnated with it, has the property of +destroying colours, and chlorine is, on that account, much employed in +bleaching, in the forms of “Bleaching Powder” and “Tennant’s Powder.” + +When chlorine gas is disseminated through an apartment, any stench, +however strong and intolerable, which may have been present there, is no +longer perceptible, the odour of the chlorine taking its place, or so +completely covering it, as to render it no longer cognisable to the +senses. + +Chlorine gas is employed both alone, and in combination with other +bodies, as lime and soda. + +In combination with these alkalis, chlorine forms the chlorides of lime +and soda. The former is well known in this country, and the latter, when +dissolved in water, forms the “Liqueur disinfectante” of Monsieur +Labarraque, which is much celebrated on the Continent. + +The solutions of these salts in water, are sprinkled occasionally +through the apartments which are to be purified. + +When these solutions are sprinkled about, and exposed to the action of +the air, the chlorine escapes in its gaseous form and mingles with the +atmosphere, while the lime and soda, which are now uncombined, attract +and unite with any carbonic acid which may have arisen from the patient, +his clothes, or excretions. + +The solution of chloride or chloruret of lime, answers sufficiently +well, but as it is to be obtained in all drug shops, it is unnecessary +to add here a formula for its preparation. + + + FORMULA FOR THE PREPARATION OF CHLORINE GAS. + +Take three parts of common salt, one of black oxide of manganese, and +three of strong oil of vitriol. Mix the salt and the oxide together in a +stoppered retort, pour in the oil of vitriol and apply a gentle heat. +The gas is immediately evolved, and rapidly diffuses itself throughout +the atmosphere. Muriatic acid gas, a combination of chlorine and +hydrogen gases, though considered as inferior to chlorine as a +fumigation, is frequently employed for the purpose of decomposing +effluvia, as the materials for its preparation are almost ever at hand. + + + FORMULA FOR OBTAINING MURIATIC ACID GAS. + +Put a handful of common salt previously made very hot into a saucer, and +pour over it an ounce of strong oil of vitriol. The gas is immediately +extricated. + +It has been already said that the fumigations just noticed are on many +occasions highly useful, and their employment is much recommended in all +situations where the atmosphere is liable to be contaminated by effluvia +from sick persons or from dead bodies; but it is not therefore to be +understood that, because the use of these agents has been advocated, it +is for the purpose of destroying atmospheric contagion, of decomposing +the specific animal poisons which have been supposed to be present, and +dissolved in the atmosphere, which is the object, or one of the objects, +held in view by the generality of those who advise the use of +fumigations. These fumigations have been recommended with the view of +correcting what has been treated of as vitiated air, which is distinct +from, but which has long been erroneously regarded as, Atmospheric +Contagion. On some occasions, great fires of wood, coal, pitch, +gunpowder, and the like, have been recommended for the purpose of +destroying contagion and purifying the atmosphere. During the prevalence +of the plague in London, great fires were kindled in the streets, and, +according to some historians, with considerable benefit. + +Such great fires produce great agitation of the atmosphere, and it is +possible that in this way they may prove useful in improving the +condition of that fluid, particularly when, as happened occasionally +during the visitations of plague in London, the weather is sultry and +close, and when the atmosphere is confined and little agitated, and +allowed almost to stagnate. + +There is much reason to think that the agitation of the ocean, by its +waves and tides, is not more favourable to the preservation of the +purity of its waters, than the movement of the atmosphere, by winds and +currents, is to the maintenance of its wholesome condition, and when +this is lost, to restore it; and in the absence of winds, and when +pestilence is raging, the use of combustion on a large scale may with +advantage be adopted; but in this climate, where the weather is seldom +long calm, the occasions for the employment of that agency can be very +rare indeed. + +Heat is much used for the purpose of dissipating effluvia, and purifying +goods, clothes, letters, &c., which are supposed to be impregnated with +contagious matter, or other unwholesome impurities; and there is good +evidence to shew that this agent is perhaps the most powerful instrument +which is ever employed for the purpose in question. + +Heat when applied to an atmosphere containing effluvia will rarefy it, +cause it to become lighter, and dissipate it, amid the atmosphere above, +where any opportunity is afforded for its egress; and when the heat is +employed in the sick chamber, much good is effected by the dissipation +of the damp and condensed vapour which cannot fail to be frequently +present in that situation. + +In the sick chamber, the presence of a fire for even an hour daily is +highly useful where there is little opportunity for ventilation, and +when the external atmosphere is damp and motionless, for the heat +issuing from it, will dislodge and dissipate any effluvia which may have +become condensed, and have fastened on the furniture of the apartment. + +The condensation of effluvia, &c., is thus depicted in the “Mussulman.” +The apartment is that of a prison. —— The pestiferous breath of the +surviving was mingled with the effluvia from the dead, and the +empoisoned exhalation was condensed on the damp walls, and was seen +trickling down in drops of poison to the ground.[10] + +Footnote 10: + + The Mussulman by Madden. + +Heat, when applied to clothes which are impregnated with specific +contagious matter, or merely impurities or condensed effluvia, is +calculated to be highly useful, and where washing cannot be adopted, +should never be neglected. Clothes which are thus tainted will be +deprived in a great measure of their power of doing mischief, by placing +them before a fire for a considerable time, for there is good reason to +think that specific contagious poisons will be decomposed, and it is +ascertained that condensed effluvia may be dissipated by the application +of a smart heat. + +The following experiment will at once illustrate the property which some +bodies possess of absorbing effluvia from the atmosphere, and prove the +influence of heat in again expelling and dissipating them. Pure sand, +exposed to a red heat to drive off impurities, was put amidst tainted +air. Put into a glass tube and exposed to a spirit lamp, it yielded +ammonia or hartshorn,—a product of putrefaction which the sand had +undoubtedly absorbed from the tainted atmosphere. Ammonia is a compound +of nitrogen and hydrogen, gases which are evolved during the +putrefaction of animal materials. + +The investigation of the means by which persons, merchandize, clothes, +letters, &c., may be most speedily and most effectually freed from +effluvia, contagion, and other unwholesome impurities, is a most +important point, for it relates to the most vital interests of society, +commerce, freedom of intercourse, personal liberty, and the safety and +health of the community. But from the very important considerations with +which the investigation is connected, the merits of the respective means +employed for the purpose will not be treated of here, as they deserve a +more extended consideration than can be given. In the mean time it would +be highly dangerous and impolitic, to adopt any great and rash change in +a system so important as quarantine, until the most full and sound +inquiry has been made upon the subject. Public safety demands the utmost +caution. + +There may exist great diversity of opinion respecting the nature of the +impurities with which merchandize and clothes are sometimes impregnated, +on the period during which they retain their activity, and on the means +of purification; but it has been often clearly demonstrated, that +specific contagious matter, or virus, and effluvia, may be conveyed by +these bodies, may be retained for a considerable time, and, on a +favourable opportunity, produce very hurtful effects. + +The impurities may be variously designated, yet their unwholesome +tendency is much the same, and it is necessary to adopt provisions to +counteract it. + + + + + CHAPTER XIII. + THE PREVENTION OF VITIATED AIR IN CONNECTION WITH THE DISPOSAL OF THE + DEAD—OFFALS—CONSTRUCTION OF TOWNS, HOUSES, SEWERS, &C. + + +In the Chapters which have been dedicated to the subject of Vitiated +Air, its sources were pointed out in a general manner, and it is +intended to consider those usages in society, certain conditions of +towns and houses, and some other circumstances, which favour the +production of an impure and unwholesome atmosphere, and this will be +done with the hope that a knowledge of their hurtful tendency may lead +to their correction. + +The disposal of the dead will be first considered. + +As soon as the life of man is extinct, his body becomes the seat of +chemical decomposition or putrefaction, and effluvia are exhaled from +the putrid corpse, varying in some degree, in amount, rapidity, and +activity, according as the circumstances in which it is placed are more +or less favourable to putrefaction. + +The effluvia which are exhaled are deleterious, and an atmosphere in +which they are evolved, if close, small, and confined, often becomes so +contaminated and vitiated as to be calculated to produce death by +suffocation and disease. + +The body of man after death is thus a centre of putrefaction, and the +source of agencies prejudicial to the living, and on that account alone, +it is wise so to dispose of the dead that they may not prove hurtful to +the surviving, which has been done with more or less efficiency from the +very earliest epochs of time, by various forms of burial. + +But solicitude for the safety of the living has not been the only motive +for the burial of the dead, for the destiny of man after death is +clearly pointed out, and his doom to the earth is amply shewn by various +expressions contained in the Holy Writings, and his burial or interment +has been performed in obedience to the original or divine plan. + +The interment or burial of the dead has likewise been considered as a +rite due to the memory of the deceased, and a mark of respect which the +friends and relatives were bound by every sacred obligation, to perform +with all becoming solemnity. + +To neglect the sacred office of interment, or any of the solemnities +usually in practice, was, even among the earliest Greeks and Romans, to +treat the memory of the departed with the grossest disrespect and +indignity. + +The denial of burial, with all its formalities, was esteemed by the +Greeks as a mark of infamy due only to villains, traitors to their +country, and those who died in debt, and the bodies of such characters +were accordingly decreed unfit for ordinary interment. + +The Jews interred the bodies of the dead for the most part contiguous to +the high ways, in gardens, and on hills. + +The Greeks and Romans interred their dead in the ground which surrounded +their sacred buildings, and at the gates and porticoes of their temples. + +The Saxons, Danes, and other Scandinavian nations, enclosed the bodies +of the deceased in stone coffins, which were placed or built at the +distance of two or three feet from the surface of the earth. + +At this day, these stone coffins are occasionally discovered at a little +depth from the surface. Some such coffins were lately discovered in the +parish of Gladsmuir, in East Lothian, by the coulter of the plough +coming in contact with them. On examination, the coffins were found to +be only a foot and a half below the earth’s surface:—they were about +five feet long, and were composed of several stones fitted together, or +built up. Within were found human bones of the adult size, quite entire +in figure, but so friable, as to fall to powder along with the clay in +which they were imbedded, on being handled. The vertebræ or bones of the +spine, which are at present in my possession, present the same accuracy +of outline to be found in the recent skeleton. + +The situation at which these coffins were found, is the very summit of +Seton Hill, a point which commands a view of the surrounding country to +a very great extent, and of the Forth, from its mouth to its meanderings +in Stirlingshire, and which there is much reason to think, may have been +at a very early time, a Danish or Saxon encampment. + +The Hindoos dispose of their dead or dying by throwing them into the +Ganges, where they rot and decompose. + +In this country the dead are interred at a much greater distance from +the surface than was practised by the Scandinavian nations, generally at +the depth of five, six, or eight feet, and sometimes even more. + +After death, corpses are usually kept several days before interment, and +as the temperature of this climate is seldom very great, bad effects are +very seldom experienced, and in that respect, Britain is very unlike +some tropical regions, where, almost as soon as death has taken place, +it becomes necessary to bury the bodies of the deceased in order to +avoid the noxious vapours, which are immediately emitted. + +During the time the corpse is kept before interment, attention should be +paid to secure a full and frequent change of air, which is best obtained +by keeping the windows partly open, by volatilizing vinegar, or by +sprinkling the apartment occasionally with the solution of chloride of +lime. + +The mode of burial of the present time, which is practised in this +country, is, partly from accidental circumstances, a great improvement +upon that which was in use by our ancestors; for there is much reason to +think that effluvia, proceeding from dead bodies, may percolate or be +strained through a covering of soil of only two or three feet, which may +be completely confined by one of earth and stones of five or six feet in +depth. The great depth to which graves are now dug, originated not so +much with the view of preventing the percolation of effluvia, as with +the intention of embarrassing the operations of the bodysnatcher, whose +violation of tombs is now happily at an end. But though there now +remains no occasion for adopting measures for that purpose, the good +practice of deep burial to which that evil gave rise should not be +allowed to go into desuetude from the absence of those circumstances +which called it into existence. + +It is agreeable to information which has been gathered from various +sources, to state, that effluvia may and do penetrate through the loose +soil and other materials of churchyards, when the body is placed within +three feet of the surface of the earth. + +With that covering, effluvia do not escape in large quantities at a +time, so as to produce very serious and instantaneous effects; yet a +small amount may percolate from time to time, which, by acting +constantly, without intermission, may be the mean of deteriorating or +undermining the health of those persons who live in their immediate +neighbourhood, and more especially if the situation be one which is not +readily accessible to winds and currents. + +It is stated by grave-diggers, that when a body is interred in a grave +five or six feet deep, the effluvia do not reach the surface; so that it +is evident that deep graves are much less dangerous to the living, and +should be adopted in preference to those which are shallow. It is much +to be desired, that no more burying-grounds should be opened or formed +in the heart of towns, and that those which are at present in use, in +such situations, be entirely closed against the admission of more +bodies, and that cemeteries be opened at some distance from the +habitations of men. + +Every good purpose which is at present obtained from the burial-grounds +situated in towns, might be also procured from cemeteries placed at a +little distance in the country; and many disadvantages might be avoided +in the latter situation, which attend burial-grounds in densely +populated situations. + +One great advantage to be obtained from exurban cemeteries, is the +freedom which the population would enjoy from those exhalations which +must ever arise, in a greater or less degree, from overcrowded +burial-grounds which have, for any considerable time, received the +remains of the dead, and a consequent improved state of health. + +Deep graves may for a time prove a security against effluvia, but a day +must come when these graves will be opened, and when their contents, +perhaps not yet totally assimilated with the surrounding clay,—not yet +completely deanimalized,—will be thrown to the surface, and mingled with +the soil, there to finish the process of decomposition, and there to +vitiate the atmosphere. + +The burial-grounds of our densely populated towns are actually +supersaturated, if such an expression can be used, with the partially +decomposed remains of mortality, which have not yet had time to be +assimilated with the earth, or to be “ripe,” as the grave-digger would +say. + +In general, also, those burial-grounds are so small and ill-proportioned +to the wants of the population, that it is necessary to open graves, and +heap body upon body, until they reach to within a very short distance of +the surface, or to clear the ground of its contents while they are yet +green, in order to procure a place of rest for other bodies. + +Such is occasionally the scarcity of ground, small though that space be +which will suffice for any one individual, that ere a few short years +have rolled away, the intrusive spade of the indifferent sexton disturbs +the grave, perhaps of a friend,—that place where peace was promised and +through life expected;—his ashes are rudely handled, and his bones, not +yet denuded of their flesh, are cast without remorse amidst the +rubbish;—and thus the best feelings of humanity are outraged, and the +human heart, already wrung with anguish, is crushed or cruelly +lacerated. + +It will perhaps be urged in reply, that the vicinity of burial-grounds +in the large towns of Great Britain are not more unhealthy than other +quarters. + +But the answer to this is, that no extended and minute inquiry has been +instituted on the subject; that though the absolute amount of disease +may not be increased (which, however, has not been shewn), still, a part +of the disease which does occur, may arise from the operation of the +emanation from the burial-grounds; and, lastly, it must be obvious to +all who are sensible of the advantage of a pure atmosphere, that the +effluvia which necessarily prevail in those situations, must be +prejudicial to health, whether it be in an amount, or intensity, or +mode, to admit of the detection of the relation between them, as cause +and effect. + +If, perchance, in some instances, no prejudicial influence is exerted +upon the health of persons inhabiting the neighbourhood of +burial-grounds, that fortunate immunity from the ordinary effects of +effluvia arising from decomposing animal remains, accumulated in large +quantities, is to be attributed, not to the innocence or innocuous +nature of the emanations, but to the wholesome influence of winds and +currents, in securing a constant supply of pure air, and which prevent +the accumulation of these gaseous poisons in quantities sufficient to +produce the bad effects which are commonly experienced in situations +where they are much concentrated. It is almost impossible to adopt +measures which will completely prevent the admission of effluvia from +burial-grounds into the atmosphere, and it were therefore wise that the +evil, a necessary one as it would appear to be, should be made to exist +where it is least likely to do harm,—and that situation is certainly in +the country, in the open fields, where there are few or no houses. + +It is to be hoped that the subject of exurban cemeteries will shortly +obtain the consideration of the government of this country, and of the +magistrates of the various towns,—as it involves interests of the most +important nature. + +Several large towns have already cemeteries at a little distance in the +fields; and among others, Glasgow has its City of the Dead, or +Necropolis, as it is styled, which is situated on a height adjoining the +town. + +Paris, the capital of that country which has produced many of the most +eminent chemists, has not been tardy to avail itself of the light which +their philosophers have thrown upon the composition of animal bodies, +and the chemical constitution of the atmosphere. That capital boasts a +magnificent cemetery, called Pere la Chaise, which is situated at a +little distance in the open country. + +Pere la Chaise is becoming, as the Place of Rest of the dead, worthy to +hold the ashes of departed mortality. There the bodies of men can in no +way be hurtful to the health of those who survive; there, now incapable +of being useful, they are at least harmless to that community of which +they lately formed a part. There the silence—the proper silence—of the +tomb is maintained; there a serenity of aspect exists, which comports +well with the solemn, the quiescent state of its inhabitants; and there +is a cheerfulness, and a beauty, aye a brightness, of a softened, and a +mellowed kind, which seem to refer to the pure enjoyments of the +promised land. There, as in the burial-grounds situated in our thickly +populated towns, there is no obvious and striking unwholesomeness, no +offensive and humiliating appearance of mortal remains, to deter from a +casual glance, or from entrance on the part of the friends and relatives +of the departed. On the contrary, in Pere la Chaise, they are invited +and allured by the softened and chastened beauty of the place, and +there, without endangering their health from close and vitiated air, +they linger by the ashes of the dead, and revolve those solemn thoughts, +so wholesome and so heavenward bending to the soul;—there the bereft +parent is seen giving the reins to his feelings, fondly recalling +cherished associations, and there he is learning to hear unappalled that +he must share a like fate with that of the object whose grave he now +regards;—there may be seen the orphan, come to shed the tear of filial +love over the manes of his departed parents, reviving ties and +affections which are too liable to be entirely worn away by youthful +enjoyment, and the various unsubstantial fascinations of the world;—and +there he learns that most useful and wholesome lesson, to look with +complacence, if not with prospective joy, on death and its silent +abode,—to divest himself of that dread and horror often excited by these +ideas, and which, alas, too frequently drive the young from such +considerations altogether. + +In Pere la Chaise, a murmur is heard proceeding from the town, and the +impression made upon the mind is, that the world is receding, that the +noise, mirth, and tumult of man is vanishing away, and that, in short, +the reign of death has commenced,—the reign of death, solemn but not +terrific. + +How different is the abode of the dead in the bustling commercial towns +of Britain. Here, solemnity is incongruously enough and offensively +mixed up with the noise and bustle of every-day concerns of men bent on +business or pleasure. Reflections on eternity are here interrupted, +perhaps by the music, or rather the ungrateful noise, of a musical +instrument being played in an adjoining street, the rolling of +carriages, the trampling of horses, the smacking of whips, and the +indecent oaths of waggoners;—while in another street, or fashionable +promenade, which the eyes of the mournful visitor of the abode of death +cannot possibly avoid, the ill comporting sight is seen, fine ladies and +still finer gentlemen laughing and tittering, busied with fantastic +displays. ’Tis an ill-assorted scene, ’tis Nature burlesqued beside +humanity defunct. + +But the improvement in burial-grounds is urged, not on the plea of +feelings and sentiments, but on that of public utility and general +health. + + + THE CLEANSING OF TOWNS. + +Until within a comparatively short period, the large towns of this +country were kept in a very unclean condition, from the accumulation of +impurities; and the consequence was, that there prevailed a vitiated and +most offensive atmosphere, which often proved hurtful to the health of +the inhabitants. + +Habits of cleanliness, and proper notions of domestic comfort have made +rapid progress of late years, and fortunately all classes of the +community enjoy clean and wholesome apartments and streets, compared +with those occupied by their ancestors of a century back; and families +at the present day, who belong to the middle class of society, have the +advantage of greater cleanliness, both of house and locality, than was +then enjoyed by persons of the higher classes. + +In many large towns an admirable system of cleansing is maintained, by +which the removal of impurities is insured, which might taint the +atmosphere. The laudable endeavours of the magistrates for this purpose, +have uniformly met that ready cooperation from the more respectable +portion of the inhabitants which they so well merit; but with the lowest +classes, whose ideas are too coarse to permit their recognising danger +in such things as uncleanliness and impure air, the suggestions of +philanthropic individuals, and the exertions of authority, have failed, +in a great degree, to produce that wholesome condition of houses and +localities which is so desirable. + +Much uncleanliness still prevails in some streets in those quarters of +towns occupied by the labouring population, which proves the source of +many effluvia, which again, it is probable, assist much in the +production of the great amount of disease which is wont to prevail in +those parts. + +There is reason to fear that a considerable proportion of the lowest +classes in all large towns is too much degraded to give themselves any +concern about lessening the tendencies to disease, or to put themselves +to any trouble to remove impurities, further than is absolutely +necessary for their own convenience; but, in such instances, the +authority of the law should interfere, and compel compliance with +regulations for that purpose, the infringement of which is calculated to +produce consequences prejudicial to the public health. + +Many, nay most, of the villages of Scotland are kept in a most offensive +and unwholesome state of filthiness; large heaps of corrupting animal +and vegetable materials being allowed to accumulate, in many instances, +in the public thoroughfares, and before the very doors and windows of +the houses, proving the source of the most abominable effluvia, +offensive to the senses of those who are accustomed to a pure +atmosphere, and injurious to the health of all who inhale them. Trenches +or hollows are, in many instances, to be found before the doors, where +water is collected, and forms a nidus for the putrefaction of the +materials above mentioned, and whence issue effluvia which are often to +be recognised in the houses. + +In these hollows or cavities are thrown all sorts of impurities, and +they are allowed to remain till a cart-load or two have accumulated, +when, if sufficiently decomposed, they are sold as manure to farmers and +others, at the rate of about a shilling the cart-load. + +The collection of impurities is in this case not the result of apathy +and laziness, as in the purlieus in large towns, but of the desire of +gain, or of a trifling advantage, such, for instance, as getting a small +piece of ground, rent free, for the growth of potatoes, which is a +common practice. + +Very bad consequences attend the unwholesome condition of the atmosphere +always found in these situations, and more especially in warm and close +weather. + +The quarter of Tranent in which typhus fever prevails most is that +called Dow’s Bounds, and a more filthy part is not to be met with in +Scotland; a large area in front of the houses being completely occupied +with the cavities afore-mentioned, with their putrefying contents, and +the place being ill adapted for ventilation, forming three sides of a +square, and the ground having no declivity, nor efficient sewers to +carry off the rain, the most favourable circumstances exist for +putrefaction, and for the contamination of the atmosphere. + +In the construction of future towns, and in additions to the old, the +utmost attention should be given to promote the free agitation of the +atmosphere, if it is proposed that they should be salubrious. Where +health is to be protected, the streets should be made wide, open, and +occasionally terminating in squares or other open places. + +Where circumstances will permit a choice, towns should be built in +wholesome situations and dry soils; and the same holds with additions +making to old towns. + +The health of a community is much influenced by the situation in which +they live, and by the nature of the ground on which their houses are +built. + +In many towns there are some particular districts in which disease is +more particularly prevalent, and the result of careful inquiry is, that +the excessive disease is owing to unwholesomeness of situation. Persons +in all other respects similarly situated, enjoy a better state of +health, or suffer less disease, who inhabit a more wholesome or less +prejudicial situation or locality. + + + SEWERS. + +A point next in importance to a proper construction of streets, and the +selection of good situations, is an efficient system of drains or sewers +for the removal of impurities, and the formation of water-courses. + +Of the importance of sewers it is unnecessary to enlarge, that being +sufficiently understood. + +By water-courses is meant channels for the immediate passage of +rainwater from off the streets. They are easily formed, and where the +ground is level, the advantage is very great. In streets having a slope +or declivity, the water is soon dispersed; but where they are level, it +is apt to collect, and there create dampness, which is communicated to +the houses, and a favourable nidus for putrefaction, where impurities +are permitted to accumulate. + +In some parts, principally the suburbs of large towns, and in many of +the villages of Scotland, perhaps more especially those along the +coasts, inhabited by fishermen, no means being adopted to expedite the +removal of rainwater, and there being no natural water-run or course, +the rain collects, and animal and vegetable materials mixing therewith, +green putrefying ditches are formed, plentifully evolving gaseous +products, and supporting a luxuriant vegetation on their surface. + + + CONSTRUCTION OF HOUSES. + +So much attention is now paid to health and comfort in the construction +of the houses of the wealthy, that it is unnecessary to say a word +respecting these points, in connection with the higher classes. + +But the circumstances being so very different in relation to the houses +of the poor or the labouring class, some notice is required here. + +It too often happens that the house of the labouring man in the country +is, in almost every respect, little better than a shed, and calculated +to produce disease. The walls are frequently the only substantial part +of the tenement, the roof of tiles being often pervious to the rain and +wind, and there being no other covering either of lath or lime; the door +opens directly into the body of the house, and the floor is generally +either below or on a level with the ground outside. + +When floors of houses are below the level of the ground outside, they +must necessarily be damp, and cause the house to be unwholesome. + +The floors even of cottages should be situated about a foot or more +above the level of the adjacent ground, and the interval between them +and the soil should be filled up with small stones, or such materials, +and then the houses might possibly be free of damp, and the rain would +not run in off the streets, and form ditches before the very fire-place, +as it does in many houses in this village. + +The necessity of the floors of their houses being at a little distance +above the ground is well known to the natives of Manilla. To avoid the +dampness and the unwholesome emanations of the soil, the poor natives +build their bamboo houses upon a foundation of wooden piles, by which +contrivance a considerable space is left to permit the winds to enter, +and to dissipate the damp and exhalations. In like manner, the rich +inhabitants of Manilla build on piles of brick. Could our working +population, or rather their landlords, not take a hint from these less +refined people, and form some security against that unwholesomeness +inseparable from damp houses? + +It is unnecessary to detail at length instances of the greater +prevalence of disease among the inhabitants of low-lying, confined, +damp, ill ventilated, and filthy towns, over the populace of cities more +favourably situated in these respects. + +It will suffice to say, that typhus fever prevails more in the Old Town, +where there are many local causes of disease, than in the New Town of +Edinburgh, where the streets are clean, wide, and well drained;—and that +the plague prevails more in the Jews’ quarter, remarkable for the filth +and closeness of the streets, than in any other part of Constantinople. + + + + + CHAPTER XIV. + PREVENTION OF DISEASE BY AN ACTIVE AND CHEERFUL STATE OF MIND, + SUFFICIENT CLOTHING, AND WHOLESOME DIET. + + +The bad effects of despondency and apprehension have been already +stated, and they were found to be very important and highly favourable +to the invasion of disease. Instances have already been given of disease +and general decline of health following depression of mind and long +continued apprehension, and it now remains to point out the salutary +action of an active and cheerful state of mind. + +An active and cheerful state of mind imparts an activity to the various +organs of the body, whereby their functions are more perfectly +performed; it spreads a kindly glow over the entire system, and tends to +dispel any sluggishness of action present in any part which perhaps +would, under other circumstances, increase, and lead to the development +of disease. + +On some occasions a cheerful state of mind, induced by sudden +improvement of prospects, or by the unexpected receipt of good +intelligence, has been the efficient instrument in dispelling the first +symptoms of disease which had been induced by depressing causes. + +It has been often observed among soldiers and sailors, who, losing their +health and beginning to suffer from disease, under no other apparent +unwholesome cause than the distrust with which they regarded an +insufficient and unskilful commander, that their health has suddenly +improved, and disease has rapidly diminished when they have been put +under an able chief in whom they reposed confidence, and with whom they +were willing and ready to place the safety of their lives. + +Soldiers and sailors suffering many privations, mortified with defeat, +failing in their energies, and beginning to drop under the influence of +disease, have, on the sudden and unexpected brightening of their +prospects, regained their lost strength, cast out the seeds of disease, +thrown off their despondency, and have achieved worlds of enterprise. +The following interesting case, which illustrates well the powerful +influence of hope, and a cheerful state of mind, is taken from Paris’s +Pharmacologia. + +“In the celebrated siege of Breda in 1625 by Spinola, the garrison +suffered extreme distress from the ravages of scurvy, and the Prince of +Orange being unable to relieve the place, sent in, by a confidential +messenger, a preparation which was directed to be added to a very large +quantity of water, and to be given as a specific for the epidemic; the +remedy was administered, and the garrison recovered its health; when it +was afterwards acknowledged that the substance in question was no other +than a little colouring matter.” + +That impaired state of health, and much of the disease, especially of +the digestive organs, which is so much experienced by persons who are +suddenly deprived of much occupation of the mind in business, and find +themselves totally unemployed, and who, from their previous habits, are +unable to derive enjoyment from literary and scientific pursuits, as +some retired tradesmen, have been suddenly removed, and health has been +fully re-established on the individuals being again immersed in +business, either from choice or by a happy reverse in their +circumstances rendering that step unavoidable. + +During epidemics, that confident assurance which some persons are known +to entertain, that they will escape the prevalent distempers, there is +much reason to think, has on many occasions been a complete prophylactic +or preventive. + +Instances are not uncommon where an assurance or settled conviction on +the part of the patient has gone far to promote, if not to produce, +recovery from very dangerous disease, when physicians have despaired of +life, and even when that opinion has been communicated to the unmoved +and still confident sufferer. + +The history of amulets or charms and of the cures performed by the royal +touch, affords much amusing and interesting detail illustrative of +confidence and hope, in the prevention and cure of disease. Instances +are also familiar of naval and military officers who have lost their +health from the long continued suffering of “hope deferred” in respect +to promotion, and of neglect of meritorious services, where advancement +and the grant of their longing and earnest wishes has at length acted as +a charm upon every bodily ailment, and where a rapid succession of +cheerfulness and health has been the immediate consequence, to the joy +of anxious and apprehensive friends. + +The beneficial effects of activity and cheerfulness of mind in warding +off the attack of disease, and in promoting recovery therefrom, having +been so strikingly illustrated in the above examples, there remains no +occasion to say more than to recommend them strongly for adoption, both +among those in health and in sickness. + + + CLOTHING. + +The want of sufficient clothing as productive of disease has been +already noticed. + +Clothing in this climate is used for the purpose of retaining the body +warm. Now this is an important purpose, and the means by which it is +attained are highly deserving of notice, and they exert a very powerful +influence upon health. + +The temperature of the human body is generally about 98° Fahrenheit, and +that of the surrounding atmosphere being in this climate always below, +sometimes in severe winters, as for instance the last, being near zero. + +Now, all bodies possess a property by which they are disposed to +maintain an equilibrium of temperature, that is, to be of the same +amount of heat, and the temperature of the human body being above that +of the surrounding atmosphere, in an amount varying at different times, +it parts with a portion of its heat, or caloric, as it is called by +chemists, which is communicated to the atmosphere and surrounding +bodies. + +A portion of the heat of the body is constantly, and under all +circumstances, being abstracted by the atmosphere and other surrounding +bodies which are at a lower temperature, and were it not that the loss +of heat, which the body is thus constantly sustaining, is supplied by +the formation of heat in the system, which is ever going on, the body +would soon become so very cold as to be incapable of performing its +functions, and death would consequently ensue. + +The amount of heat which the body loses, and the rapidity with which it +is abstracted, is proportionate to the coldness of the atmosphere and +surrounding bodies. + +But the rapid and great abstraction of heat from the human body, which +is apt to take place when it is immersed in a very cold atmosphere, is +very hurtful, and often induces disease, especially fevers, colds, +coughs, and inflammations. + +It is for the purpose of checking the rapid abstraction of heat from the +body, that the warm clothing used in these latitudes is adopted. It is a +bad conductor of heat, and the consequence is, that the temperature of +the body is not reduced so rapidly as it would be were it exposed +without any covering to the atmosphere, which, more especially when +damp, is a superior conductor of heat. + +Clothing of a sufficient nature is useful in the preservation of health, +by preserving in its integrity the circulation of the blood on the +surface of the body, by maintaining the constant flow of the secretion +from the skin, or perspiration as it is commonly called, which is so +useful to the system in many different ways, and by preventing any +deviation from that balance in the distribution of the fluids of the +body which that process goes so far to maintain, much to the comfort and +freedom from disease of the individual. + +Many instances of a very striking nature are known, where such +inveterate and mortal disease has supervened in consequence of the +privation, total and partial, of clothing, and from that being of a +texture and nature inadequate to meet the exigencies of the case. Some +have been referred to in this work where the want of sufficient clothing +has been one of many concurrent potent circumstances, the attendants and +consequences of poverty and destitution which have given rise to +epidemics. On occasions of great distress and destitution, the disease +which is then so very prevalent is not the product of one circumstance +merely, such as want of food, but is induced by the many concurrent +powerful and unwholesome influences to which poverty is ever sure to +give rise. One of the chief circumstances on which the wide prevalence +of disease depends on those occasions, there can be little doubt, is +insufficiency of clothing among the poorer classes. But it is the +advantages which are to be derived from sufficient clothing which should +here occupy attention. Of late years, it has been the practice in some +towns in this country, on occasions of fever and other diseases +prevailing during the cold and inclemency of winter, for funds to be +collected for the purchase and distribution of clothes among the poor +and ill-clad portion of the population. + +The motives and feelings with which this form of charity has been +adopted, must of themselves be a sufficient and highly delightful return +for the liberality and exertions of its benevolent projectors and +supporters, but it must afford them much gratification and much +encouragement in their laudable and christian endeavours, to know that +the clothing which they have dispensed has had a powerful influence in +preserving many from becoming the victims of the prevalent distempers, +and of preventing the relapse of the convalescent. + +The late Sir John Pringle, a distinguished army surgeon, states that +“the best clothed were generally among the most healthy regiments.” + +The quantity of clothing should of course vary with the season, more +being used in winter than in summer. A minute account of the outer +clothing is unnecessary here, but a word may not be thrown away; the +body should at all times have that quantity of clothing which will +secure it from unpleasant feelings of cold and chilliness, and it would +be wise to be influenced more by comfort and a regard to health, and +less by fashion and caprice in the choice of clothing, which is so +intimately connected with the preservation of health and its unspeakable +comforts and enjoyments. + +The clothing which is next the skin is more important, and will here +obtain some consideration. It may be laid down as a general rule that +flannel or some such woollen cloth should be used next the skin +throughout the entire year. It will be well to vary the cloth or flannel +in different seasons, perhaps using a thick flannel during winter, and a +material of lighter and less close texture during summer and autumn. A +fabric of fine flannel, or what is called “stocking,” answers very well +for the summer, when the flannel which is commonly used is felt to be +too warm and irritating to the skin. In the summer it is common for many +persons who use flannel during winter to discontinue its use, but it is +safer, merely to exchange the thick flannel which has been used during +winter for one of a finer fabric or some such equally fine material. + +During winter when the weather is always cold, and in spring when it is +generally chilly, flannel or some such material should form an essential +portion of the clothing of every inhabitant of these islands. + +It is safe to say that hundreds in this country are at present alive and +enjoy excellent health who, but for the use of flannel and such like +fabrics next the skin, would have been, ere this, numbered with the +dead; and it is not too much to say that thousands are at this moment in +perfect health through the kindly action of the same clothing, whose +lives were threatened with constant coughs, periodical colds, quinseys, +rheumatisms, and incipient disease of lungs, and other organs of the +chest, before this efficient guardian of health was adopted. + +Flannel and fabrics of the same or like nature go far to preserve an +equable temperature at the surface of the body, promote the perspiration +of the skin, which they readily absorb when copiously secreted, and are +specially useful in preserving the balance of the secretions on the +surface and in the interior of the body. Now all these most important +conditions, which the use of flannel goes so far to maintain, are ever +liable to be subverted and disturbed, whenever the body is thinly or +inadequately covered, by changes in the ever varying temperature of the +atmosphere, and by the prevalence of winds and currents. + +Most of the important constitutional diseases which occur in this +country, begin with a sensation of coldness with shivering and +trembling; now it is the usual property of flannel, and such fabrics, +when worn next the skin, and indeed of warm and general good clothing, +to obviate and prevent these conditions of the body, and thus disease +may be met at its very onset, and perhaps baffled ere it has time to +establish its dominion. + +“In some situations my personal experience enables me to vouch for the +utility of flannel. Of this we had a very striking proof in the second +battalion of the Royals, while suffering from a most aggravated form of +dysentery in India. General Conran, the late Lieutenant-Governor of +Jamaica, who at that time commanded the Royals, was so fully persuaded +of the benefits likely to accrue from the general use of flannel, that +he went down from Wallajahabbad, where the regiment was then stationed, +to Madras, on purpose to represent to the government the distress of his +men, and to suggest the expediency of a supply of flannel shirts. This +he did with so much effect, backed by the late Dr Anderson, the +Physician-General, that the flannels were immediately ordered, and, in +my opinion, contributed much to check the alarming progress of the +disease.”[11] + +Footnote 11: + + Ballingall’s Military Surgery. + +It is usual with many individuals to wear flannel only over the chest, +but it is wise to envelope the whole body in that most useful article of +clothing. + +The poor or labouring man should endeavour to procure thick soled shoes, +in good repair, and substantial worsted stockings. + +The latter are generally esteemed stronger and more durable when made at +home, and will form excellent work for his wife or daughter in the +winter nights. + +The working man will find, that though clothing substantially, as has +been above recommended, takes a considerable proportion of his money +immediately out of his pocket, he will be a certain gainer in the end, +aye, probably in the course of a few years or months, by consequent +immunity from disease, and from continued capacity for labour. + + + FOOD. + +It has been already shewn in this work, that the want of sufficient and +wholesome food is frequently attended and followed by disease. It is now +proposed to shew how important food and drink, of good quality, are to +the preservation of health; but the fact is so well known, and so +undoubted, that it is almost unnecessary to say that they are essential +to the preservation of the body in its strength and dimensions. + +That sense of sinking and languor, which is so commonly experienced upon +long fasting, would soon be exchanged for the actual pains of disease, +were it not to be removed shortly by the taking of food. + +When the body is exhausted from the want of food for some hours, a good +and ample repast imparts strength to the body, and cheerfulness to the +mind, and goes far to prevent the evasion of some forms of disease. + +An individual who is well fed, is generally more secure against the +invasion of disease of a low character, than another who is only +scantily and occasionally supplied with food. + +It is generally believed that individuals who have lately partaken of +food, are less subject to the operation of vitiated air, or as it is +commonly termed, “contagious air;” and it was commonly reported during +the late prevalence of cholera, that persons who took breakfast before +going out, suffered less from that disease than those who followed a +contrary course. + +Many well authenticated instances are recorded of the health of armies +undergoing very great improvement, and of disease in these bodies being +greatly checked by the distribution of ample wholesome food, and by the +privation which they had suffered for some time previous, being ended, +by some accidental circumstances, as the gaining the enemy’s magazines, +or the reduction of a siege. Sir George Ballingall relates in his work +on Military Surgery, that “during the prevalence of a malignant fever in +this regiment (33d), then stationed in the garrison of Hull, in the +autumn of 1817, amongst other measures calculated to check the rapid +extension of the disease, I recommended the regular supply of breakfast +to the men. This was immediately ordered by the commanding officer, and +nothing appeared either to the officers, to the soldiers, or to myself, +to have so much effect in obviating attacks of the fever.” + +The institution of soup kitchens in this country, for the distribution +of wholesome and nourishing food to the perishing poor, there is no +doubt, has a most salutary influence in the prevention of disease, by, +in short, so fortifying individuals, otherwise incapable of resistance, +as to render them proof against the influence of many causes of +pestilence. + +There can be little doubt that the liberal distribution of nutritious +food, which of late years has happily taken place from these charitable +institutions, has gone far to check the ravages of fever, which is so +prevalent in this climate, during winter, when the labouring classes are +subject in so great a degree to cold, and the privation of food and +other necessaries of life. + +It is stated on good medical authority, that no measure which was +instituted for the purpose of stopping the progress of typhus fever in +Glasgow, in the winter of 1837–8, then very prevalent and mortal, was so +useful, and so immediately and obviously efficient, as the establishment +of soup kitchens in that city. + +Among the arrangements in Edinburgh in 1832, which tended apparently to +render cholera less extensive than in other large towns, a soup kitchen +formed one. + +Fever has been much less prevalent in Tranent during the present, than +for many winters past, and this is to be attributed partly to a soup +kitchen which has been instituted in that village, and which has been in +operation for about two months (16th March 1839). + +The excellent tendency of such establishments must be obvious to all who +are at all conversant with the nature of disease, and the animal +economy, and it can form no valid objection to that proposition, that +fever is still known to have raged where soup kitchens have been +established; for, though the pestilence may not have been extinguished, +still it may have been abated, and though the malignant character and +mortality may not have been reduced, still these excellent institutions +may have been the means of preventing their being increased. + +Let not, therefore, those who are willing and able to support whatever +is calculated to reduce the sufferings and privations of the poor, be +driven from extending their support to soup kitchens, because they have +only diminished the number of the victims of disease, and made the stage +of convalescence more sure and less liable to relapse. + +It would indeed be vain to expect, that the distribution of food would +act as an entire preventive of fever and disease, which is the result +not of scanty food only, but of that and many other circumstances of a +very different nature, whose operation, the supply of soup, in any +quantity, can go a very short way only, to remedy. + +Some of the circumstances which exert the most important influence in +the production of pestilential disease, and the measures which are best +calculated to counteract their pestiferous tendencies, have now been +detailed. + +It is hoped the enforcement of the hurtful operation of many +circumstances, erroneously thought to be innocent, may lead to their +being remedied in future, and it is expected, that if the suggestions +which have been thrown out in the latter part of this work, are duly +acted upon, or if others of a like nature, which may, at a future +period, emanate from another better qualified for the task, should meet +with the attention, which this object so well demands, the amount of +disease will be diminished, human suffering will be abated, and human +life extended nearer to that point of maturity which the Divinity has +decreed, and which the organization of the human body proclaims was +meant to be attained by one and all of the members of the human family. + +By avoiding the causes of disease which have been detailed in this work, +and by attending to the rules which have been laid down here and +elsewhere for the preservation of health, disease will be greatly +abated, but a mighty revolution must be accomplished in the habits, the +dispositions, and minds of men, ere mankind will enjoy that course of +health, and all that greater freedom from pain and disease, of which +their lot is capable:—but far from the consideration of the manifold +changes and long course of time which will be required to make a very +great improvement in the health of the human race, leading to apathy and +inaction, it should serve to stimulate to powerful attempts, and +persevering and reiterated efforts for amelioration. + + + END. + + + PRINTED BY NEILL AND CO. OLD FISHMARKET, EDINBURGH. + +------------------------------------------------------------------------ + + + + + TRANSCRIBER’S NOTES + + + ● Typos fixed; non-standard spelling and dialect retained. + ● Enclosed italics font in _underscores_. + + + +*** END OF THE PROJECT GUTENBERG EBOOK 75284 *** |